Emotional and Social Development in Middle Adulthood homework help

Emotional and Social Development in Middle Adulthood homework help

chapter 16 Emotional and Social Development in Middle Adulthood

image1

Midlife is a time of increased generativity—giving to and guiding younger generations. Charles Callis, director of New Zealand’s Olympic Museum, shows visiting schoolchildren how to throw a discus. His enthusiastic demonstration conveys the deep sense of satisfaction he derives from generative activities.

chapter outline

· Erikson’s Theory: Generativity versus Stagnation

· ■ SOCIAL ISSUES: HEALTH Generative Adults Tell Their Life Stories

Other Theories of Psychosocial Development in Midlife

· Levinson’s Seasons of Life

· Vaillant’s Adaptation to Life

· Is There a Midlife Crisis?

· Stage or Life Events Approach

Stability and Change in Self-Concept and Personality

· Possible Selves

· Self-Acceptance, Autonomy, and Environmental Mastery

· Coping with Daily Stressors

· Gender Identity

· Individual Differences in Personality Traits

· ■ BIOLOGY AND ENVIRONMENT What Factors Promote Psychological Well-Being in Midlife?

Relationships at Midlife

· Marriage and Divorce

· Changing Parent–Child Relationships

· Grandparenthood

· Middle-Aged Children and Their Aging Parents

· Siblings

· Friendships

· ■ SOCIAL ISSUES: HEALTH Grandparents Rearing Grandchildren: The Skipped-Generation Family

· Vocational Life

· Job Satisfaction

· Career Development

· Career Change at Midlife

· Unemployment

· Planning for Retirement

image2

One weekend when Devin, Trisha, and their 24-year-old son, Mark, were vacationing together, the two middle-aged parents knocked on Mark’s hotel room door. “Your dad and I are going off to see a crafts exhibit,” Trisha explained. “Feel free to stay behind,” she offered, recalling Mark’s antipathy toward attending such events as an adolescent. “We’ll be back around noon for lunch.”

“That exhibit sounds great!” Mark replied. “I’ll meet you in the lobby.”

“Sometimes I forget he’s an adult!” exclaimed Trisha as she and Devin returned to their room to grab their coats. “It’s been great to have Mark with us—like spending time with a good friend.”

In their forties and fifties, Trisha and Devin built on earlier strengths and intensified their commitment to leaving a legacy for those who would come after them. When Mark faced a difficult job market after graduating from college, he returned home to live with Trisha and Devin and remained there for several years. With their support, he took graduate courses while working part-time, found steady employment in his late twenties, fell in love, and married in his mid-thirties. With each milestone, Trisha and Devin felt a sense of pride at having escorted a member of the next generation into responsible adult roles. Family activities, which had declined during Mark’s adolescent and college years, increased as Trisha and Devin related to their son as an enjoyable adult companion. Challenging careers and more time for community involvement, leisure pursuits, and each other contributed to a richly diverse and gratifying time of life.

image3

The midlife years were not as smooth for two of Trisha and Devin’s friends. Fearing that she might grow old alone, Jewel frantically pursued her quest for an intimate partner. She attended singles events, registered with dating services, and traveled in hopes of meeting a like-minded companion. “I can’t stand the thought of turning 50,” she lamented in a letter to Trisha. Jewel also had compensating satisfactions—friendships that had grown more meaningful, a warm relationship with a nephew and niece, and a successful consulting business.

Tim, Devin’s best friend from graduate school, had been divorced for over five years. Recently, he had met Elena and had come to love her deeply. But Elena was in the midst of major life changes. In addition to her own divorce, she was dealing with a troubled daughter, a career change, and a move away from the city that served as a constant reminder of her unhappy past. Whereas Tim had reached the peak of his career and was ready to enjoy life, Elena wanted to recapture much of what she had missed in earlier decades, including opportunities to realize her talents. “I don’t know where I fit into Elena’s plans,” Tim wondered aloud on the phone with Trisha.

With the arrival of middle adulthood, half or more of the lifespan is over. Increasing awareness of limited time ahead prompts adults to reevaluate the meaning of their lives, refine and strengthen their identities, and reach out to future generations. Most middle-aged people make modest adjustments in their outlook, goals, and daily lives. But a few experience profound inner turbulence and initiate major changes, often in an effort to make up for lost time. Together with advancing years, family and work transitions contribute greatly to emotional and social development.

More midlifers are addressing these tasks than ever before, now that the baby boomers have reached their forties, fifties, and sixties (see page 12 in Chapter 1 to review how baby boomers have reshaped the life course). Indeed, 45- to 54-year-olds are currently the largest age sector of the U.S. population, and they are healthier, better educated, and—despite the late-2000s recession—more financially secure than any previous midlife cohort (U.S. Census Bureau, 2012b ; Whitbourne & Willis, 2006 ). As our discussion will reveal, they have brought increased self-confidence, social consciousness, and vitality—along with great developmental diversity—to this period of the lifespan.

A monumental survey called Midlife Development in the United States (MIDUS), conducted in the mid-1990s, has contributed enormously to our understanding of midlife emotional and social development. Conceived by a team of researchers spanning diverse fields, including psychology, sociology, anthropology, and medicine, the aim of MIDUS was to generate new knowledge on the challenges faced by middle-aged adults. Its nationally representative sample included over 7,000 U.S. 25- to 75-year-olds, enabling those in the middle years to be compared with younger and older individuals. Through telephone interviews and self-administered questionnaires, participants responded to over 1,100 items addressing wide-ranging psychological, health, and background factors, yielding unprecedented breadth of information in a single study (Brim, Ryff, & Kessler, 2005 ). The research endeavor also included “satellite” studies, in which subsamples of respondents were questioned in greater depth on key topics. And it has been extended longitudinally, with 75 percent of the sample recontacted at first follow-up, in the mid-2000s (Radler & Ryff, 2010 ).

MIDUS has greatly expanded our knowledge of the multidimensional and multidirectional nature of midlife change, and it promises to be a rich source of information about middle adulthood and beyond for many years to come. Hence, our discussion repeatedly draws on MIDUS, at times delving into its findings, at other times citing them alongside those of other investigations. Let’s turn now to Erikson’s theory and related research, to which MIDUS has contributed.

image4 Erikson’s Theory: Generativity versus Stagnation

image5

Through his work with severely malnourished children in Niger, this nurse, affiliated with the Nobel Prize–winning organization Doctors Without Borders, integrates personal goals with a broader concern for society.

Erikson’s psychological conflict of midlife is called generativity versus stagnation. Generativity involves reaching out to others in ways that give to and guide the next generation. Recall from Chapter 14 that generativity is under way in early adulthood through work, community service, and childbearing and child rearing. Generativity expands greatly in midlife, when adults focus more intently on extending commitments beyond oneself (identity) and one’s life partner (intimacy) to a larger group—family, community, or society. The generative adult combines the need for self-expression with the need for communion, integrating personal goals with the welfare of the larger social world (McAdams & Logan, 2004 ). The resulting strength is the capacity to care for others in a broader way than previously.

Erikson ( 1950 ) selected the term generativity to encompass everything generated that can outlive the self and ensure society’s continuity and improvement: children, ideas, products, works of art. Although parenting is a major means of realizing generativity, it is not the only means: Adults can be generative in other family relationships (as Jewel was with her nephew and niece), as mentors in the workplace, in volunteer endeavors, and through many forms of productivity and creativity.

Notice, from what we have said so far, that generativity brings together personal desires and cultural demands. On the personal side, middle-aged adults feel a need to be needed—to attain symbolic immortality by making a contribution that will survive their death (Kotre, 1999 ; McAdams, Hart, & Maruna, 1998 ). This desire may stem from a deep-seated evolutionary urge to protect and advance the next generation. On the cultural side, society imposes a social clock for generativity in midlife, requiring adults to take responsibility for the next generation through their roles as parents, teachers, mentors, leaders, and coordinators (McAdams & Logan, 2004 ). And according to Erikson, a culture’s “belief in the species”—the conviction that life is good and worthwhile, even in the face of human destructiveness and deprivation—is a major motivator of generative action. Without this optimistic worldview, people would have no hope of improving humanity.

The negative outcome of this stage is stagnation: Once people attain certain life goals, such as marriage, children, and career success, they may become self-centered and self-indulgent. Adults with a sense of stagnation express their self-absorption in many ways—through lack of interest in young people (including their own children), through a focus on what they can get from others rather than what they can give, and through taking little interest in being productive at work, developing their talents, or bettering the world in other ways.

Some researchers study generativity by asking people to rate themselves on generative characteristics, such as feelings of duty to help others in need or obligation to be an involved citizen. Others ask open-ended questions about life goals, major high points, and most satisfying activities, rating people’s responses for generative references. And still others look for generative themes in people’s narrative descriptions of themselves (Keyes & Ryff, 1998a , 1998b ; McAdams, 2006 , 2011 ; Newton & Stewart, 2010 ; Rossi, 2001 , 2004 ). Whichever method is used, generativity tends to increase in midlife. For example, in longitudinal and cross-sectional studies of college-educated women, and in an investigation of middle-aged adults diverse in SES, self-rated generativity rose throughout middle adulthood (see Figure 16.1 ). At the same time, participants expressed greater concern about aging, increased security with their identities, and a stronger sense of competence (Miner-Rubino, Winter, & Stewart, 2004 ; Stewart, Ostrove, & Helson, 2001 ; Zucker, Ostrove, & Stewart, 2002 ). As the Social Issues: Health box on page 534 illustrates, generativity is also a major unifying theme in middle-aged adults’ life stories.

image6

FIGURE 16.1 Age-related changes in self-rated generativity, concern about aging, identity security, and sense of competence.

In a longitudinal study of over 300 college-educated women, self-rated generativity increased from the thirties to the fifties, as did concern about aging. The rise in generativity was accompanied by other indicators of psychological health—greater security with one’s identity and sense of competence.

(Adapted from Stewart, Ostrove, & Helson, 2001.)

Just as Erikson’s theory suggests, highly generative people appear especially well-adjusted—low in anxiety and depression; high in autonomy, self-acceptance, and life satisfaction; and more likely to have successful marriages and close friends (Ackerman, Zuroff, & Moskowitz, 2000 ; An & Cooney, 2006 ; Grossbaum & Bates, 2002 ; Westermeyer, 2004 ). They are also more open to differing viewpoints, possess leadership qualities, desire more from work than financial rewards, and care greatly about the welfare of their children, their partner, their aging parents, and the wider society (Peterson, 2002 ; Peterson, Smirles, & Wentworth, 1997 ). Furthermore, generativity is associated with more effective child rearing—higher valuing of trust, open communication, transmission of generative values to children, and an authoritative style (Peterson, 2006 ; Peterson & Duncan, 2007 ; Pratt et al., 2008 ). Generative midlifers are also more involved in political activities, including voting, campaigning, and contacting public officials (Cole & Stewart, 1996 ).

Although these findings characterize adults of all backgrounds, individual differences in contexts for generativity exist. Having children seems to foster generative development in both men and women. In several studies, including the MIDUS survey, fathers scored higher in generativity than childless men (Marks, Bumpass, & Jun, 2004 ; McAdams & de St. Aubin, 1992 ; Snarey et al., 1987 ). Similarly, in an investigation of well-educated women from ages 43 to 63, those with family commitments (with or without a career) expressed greater generative concerns than childless women who were solely focused on their careers (Newton & Stewart, 2010 ). Parenting seems to spur especially tender, caring attitudes toward succeeding generations.

For low-SES men with troubled pasts as sons, students, workers, and intimate partners, fatherhood can provide a context for highly generative, positive life change (Roy & Lucas, 2006 ). At times, these fathers express this generativity as a refusal to pass on their own history of suffering. As one former gang member, who earned an associate’s degree and struggled to keep his teenage sons off the streets, explained, “I came through the depths of hell to try to be a father. I let my sons know, ‘You’re never without a daddy, don’t you let anybody tell you that.’ I tell them that if me and your mother separate, I make sure that wherever I go, I build something for you to come to” ( p. 153 ).

Social Issues: Health Generative Adults Tell Their Life Stories

In research aimed at understanding how highly generative adults make sense of their lives, Dan McAdams and his colleagues interviewed two groups of midlifers: those who often behave generatively and those who seldom do. Participants were asked to relate their life stories, including a high point, a low point, a turning point, and important scenes from childhood, adolescence, and adulthood (McAdams, 2006 , 2011 ; McAdams et al., 2001 ). Analyses of story lines and themes revealed that adults high and low in generativity reconstruct their past and anticipate their future in strikingly different ways.

Narratives of highly generative people usually contained an orderly sequence of events that the researchers called a commitment story, in which adults give to others as a means of giving back to family, community, and society (McAdams, 2006 ). The generative storyteller typically describes an early special advantage (such as a good family or a talent), along with early awareness of the suffering of others. This clash between blessing and suffering motivates the person to view the self as “called,” or committed, to being good to others. In commitment stories, the theme of redemption is prominent. Highly generative adults frequently describe scenes in which extremely negative life events, involving frustration, failure, loss, or death, are redeemed, or made better, by good outcomes—personal renewal, improvement, and enlightenment.

Consider a story related by Diana, a 49-year-old fourth-grade teacher. Born in a small town to a minister and his wife, Diana was a favorite among the parishioners, who showered her with attention and love. When she was 8, however, her life hit its lowest point: As she looked on in horror, her younger brother ran into the street and was hit by a car; he died later that day. Afterward, Diana, sensing her father’s anguish, tried—unsuccessfully—to be the “son” he had lost. But the scene ends on an upbeat note, with Diana marrying a man who forged a warm bond with her father and who became accepted “as his own son.” One of Diana’s life goals was to improve her teaching, because “I’d like to give something back … to grow and help others grow” (McAdams et al., 1997 , p. 689). Her interview overflowed with expressions of generative commitment.

Whereas highly generative adults tell stories in which bad scenes turn good, less generative adults relate stories with themes of contamination, in which good scenes turn bad. For example, a good first year of college turns sour when a professor grades unfairly. A young woman loses weight and looks good but can’t overcome her low self-esteem.

Why is generativity connected to life-story redemption events? First, some adults may view their generative activities as a way to redeem negative aspects of their lives. In a study of the life stories of ex-convicts who turned away from crime, many spoke of a strong desire to do good works as penance for their transgressions (Maruna, 2001 ; Maruna, LeBel, & Lanier, 2004 ). Second, generativity seems to entail the conviction that the imperfections of today can be transformed into a better tomorrow. Through guiding and giving to the next generation, mature adults increase the chances that the mistakes of the past will not happen again. Finally, interpreting one’s own life in terms of redemption offers hope that hard work will lead to future benefits—an expectation that may sustain generative efforts of all kinds, from rearing children to advancing communities and societies.

Life stories offer insight into how people imbue their lives with meaning and purpose. Adults high and low in generativity do not differ in the number of positive and negative events included in their narratives. Rather, they interpret those events differently. Commitment stories, filled with redemption, involve a way of thinking about the self that fosters a caring, compassionate approach to others (McAdams & Logan, 2004 ). Such stories help people realize that although their own personal story will someday end, other stories will follow, due in part to their own generative efforts.

The more redemptive events adults include in their life stories, the higher their self-esteem, life satisfaction, and certainty that the challenges of life are meaningful, manageable, and rewarding (Lilgendahl & McAdams, 2011 ; McAdams, 2001 ). Researchers still have much to learn about factors that lead people to view good as emerging from adversity.

image7

Carlos Arredondo, who lost his older son in the Iraq War and his younger son to suicide, now travels the country, telling the story of how he overcame despair and committed himself to campaigning for peace in his sons’ memory. After the Boston Marathon bombings in April 2013, Arredondo, a spectator, leapt into action and rescued this gravely injured bystander.

Finally, compared with Caucasians, African Americans more often engage in certain types of generativity. They are more involved in religious groups and activities, offer more social support to members of their community, and are more likely to view themselves as role models and sources of wisdom for their children (Hart et al., 2001 ). A life history of strong support from church and extended family may strengthen these generative values and actions. Among Caucasian Americans, religiosity and spirituality are also linked to greater generative activity (Dillon & Wink, 2004 ; Son & Wilson, 2011 ; Wink & Dillon, 2008 ). Highly generative middle-aged adults often indicate that as children and adolescents, they internalized moral values rooted in a religious tradition and sustained their commitment to those values, which provided lifelong encouragement for generative action (McAdams, 2006 ). Especially in individualistic societies, belonging to a religious community or believing in a higher being may help preserve generative commitments.

image8 Other Theories of Psychosocial Development in Midlife

Erikson’s broad sketch of psychosocial change in midlife has been extended by Levinson and Vaillant. Let’s revisit their theories, which were introduced in Chapter 14 .

Levinson’s Seasons of Life

Return to page 470 to review Levinson’s eras (seasons of life). His interviews with adults revealed that middle adulthood begins with a transition, during which people evaluate their success in meeting early adulthood goals. Realizing that from now on, more time will lie behind than ahead, they regard the remaining years as increasingly precious. Consequently, some make drastic revisions in their life structure: divorcing, remarrying, changing careers, or displaying enhanced creativity. Others make smaller changes in the context of marital and occupational stability.

· Whether these years bring a gust of wind or a storm, most people turn inward for a time, focusing on personally meaningful living (Neugarten, 1968b ). According to Levinson, to reassess and rebuild their life structure, middle-aged adults must confront four developmental tasks. Each requires the individual to reconcile two opposing tendencies within the self, attaining greater internal harmony.

· ● Young–old: The middle-age person must seek new ways of being both young and old. This means giving up certain youthful qualities, transforming others, and finding positive meaning in being older. Perhaps because of the double standard of aging (see pages 516 – 517 in Chapter 15 ), most middle-aged women express concern about appearing less attractive as they grow older (Rossi, 2005 ). But middle-aged men—particularly non-college-educated men, who often hold blue-collar jobs requiring physical strength and stamina—are also highly sensitive to physical aging. In one study, they were more concerned about physical changes than both college- and non-college-educated women, who exceeded college-educated men (Miner-Rubino, Winter, & Stewart, 2004 ).

Compared with previous midlife cohorts, U.S. baby boomers are especially interested in controlling physical changes—a desire that has helped energize a huge industry of anti-aging cosmetic products and medical procedures (Jones, Whitbourne, & Skultety, 2006 ; Lachman, 2004 ). And sustaining a youthful subjective age (feeling younger than one’s actual age) is more strongly related to self-esteem and psychological well-being among American than Western-European middle-aged and older adults (Westerhof & Barrett, 2005 ; Westerhof, Whitbourne, & Freeman, 2012 ). In the more individualistic U.S. context, a youthful self-image seems more important for viewing oneself as self-reliant and capable of planning for an active, fulfilling late adulthood.

· ● Destruction–creation: With greater awareness of mortality, the middle-aged person focuses on ways he or she has acted destructively. Past hurtful acts toward parents, intimate partners, children, friends, and co-workers are countered by a strong desire to participate in activities that advance human welfare and leave a legacy for future generations. The image of a legacy can be satisfied in many ways—through charitable gifts, creative products, volunteer service, or mentoring young people.

· ● Masculinity–femininity: The middle-aged person must create a better balance between masculine and feminine parts of the self. For men, this means greater acceptance of “feminine” traits of nurturance and caring, which enhance close relationships and compassionate exercise of authority in the workplace. For women, it generally means being more open to “masculine” characteristics of autonomy and assertiveness. Recall from Chapter 8 that people who combine masculine and feminine traits have an androgynous gender identity. Later we will see that androgyny is associated with favorable personality traits and adjustment.

· ● Engagement–separateness: The middle-aged person must forge a better balance between engagement with the external world and separateness. For many men, and for women who have had successful careers, this may mean reducing concern with ambition and achievement and attending more fully to oneself. But women who have been devoted to child rearing or an unfulfilling job often feel compelled to move in the other direction (Levinson, 1996 ). At age 48, Elena left her position as a reporter for a small-town newspaper, pursued an advanced degree in creative writing, accepted a college teaching position, and began writing a novel. Tim, in contrast, recognized his overwhelming desire for a gratifying romantic partnership. By scaling back his own career, he realized he could grant Elena the time and space she needed to build a rewarding work life—and that doing so might deepen their attachment to each other.

People who flexibly modify their identities in response to age-related changes yet maintain a sense of self-continuity are more aware of their own thoughts and feelings and are higher in self-esteem and life satisfaction (Jones, Whitbourne, & Skultety, 2006 ; Sneed et al., 2012 ). But adjusting one’s life structure to incorporate the effects of aging requires supportive social contexts. When poverty, unemployment, and lack of a respected place in society dominate the life course, energies are directed toward survival rather than realistically approaching age-related changes. And even adults whose jobs are secure and who live in pleasant neighborhoods may find that employment conditions restrict possibilities for growth by placing too much emphasis on productivity and profit and too little on the meaning of work. In her early forties, Trisha left a large law firm, where she felt constant pressure to bring in high-fee clients and received little acknowledgment of her efforts, for a small practice.

Opportunities for advancement ease the transition to middle adulthood. Yet these are far less available to women than to men. Individuals of both sexes in blue-collar jobs also have few possibilities for promotion. Consequently, they make whatever vocational adjustments they can—becoming active union members, shop stewards, or mentors of younger workers (Christensen & Larsen, 2008 ; Levinson, 1978 ). Many men find compensating rewards in moving to the senior generation of their families.

Vaillant’s Adaptation to Life

Whereas Levinson interviewed 35- to 45-year-olds, Vaillant ( 1977 , 2002 )—in his longitudinal research on well-educated men and women—followed participants past the half-century mark. Recall from Chapter 14 how adults in their late fifties and sixties extend their generativity, becoming “keepers of meaning,” or guardians of their culture (see page 471 ). Vaillant reported that the most-successful and best-adjusted entered a calmer, quieter time of life. “Passing the torch”—concern that the positive aspects of their culture survive—became a major preoccupation.

In societies around the world, older people are guardians of traditions, laws, and cultural values. This stabilizing force holds in check too-rapid change sparked by the questioning and challenging of adolescents and young adults. As people approach the end of middle age, they focus on longer-term, less-personal goals, such as the state of human relations in their society. And they become more philosophical, accepting the fact that not all problems can be solved in their lifetime.

Is There a Midlife Crisis?

Levinson ( 1978 , 1996 ) reported that most men and women in his samples experienced substantial inner turmoil during the transition to middle adulthood. Yet Vaillant ( 1977 , 2002 ) saw few examples of crisis but, rather, slow and steady change. These contrasting findings raise the question of how much personal upheaval actually accompanies entry to midlife. Are self-doubt and stress especially great during the forties, and do they prompt major restructuring of the personality, as the term midlife crisis implies?

Consider the reactions of Trisha, Devin, Jewel, Tim, and Elena to middle adulthood. Trisha and Devin moved easily into this period, whereas Jewel, Tim, and Elena engaged in greater questioning of their situations and sought alternative life paths. Clearly, wide individual differences exist in response to mid-life. TAKE A MOMENT… Now ask several individuals in their twenties and thirties whether they expect to encounter a midlife crisis between ages 40 and 50. You are likely to find that Americans often anticipate it, perhaps because of culturally induced apprehension of aging (Wethington, Kessler, & Pixley, 2004 ). Yet little evidence supports this view of middle age as a turbulent time.

image9

Emotional and Social Development in Middle Adulthood homework help

Like many midlifers, elementary school teacher Jaime Malwitz modified his career in ways that resemble a turning point, not a crisis. He designed a scientist-in-residence program for elementary schools. Here he serves as a resident physicist, discussing a density experiment with a fifth grader.

When MIDUS participants were asked to describe “turning points” (major changes in the way they felt about an important aspect of their lives) that had occurred during the past five years, most of the ones reported concerned work. Women’s work-related turning points peaked in early adulthood, when many adjusted their work lives to accommodate marriage and childrearing (see Chapter 14 ). The peak for men, in contrast, came at midlife, a time of increased career responsibility and advancement. Other common turning points in early and middle adulthood were positive: They involved fulfilling a dream and learning something good about oneself (Wethington, Kessler, & Pixley, 2004 ). Overall, turning points rarely resembled midlife crises. Even negative work-related turning points generally led to personal growth—for example, a layoff that sparked a positive career change or a shift in energy from career to personal life.

Asked directly if they had ever experienced something they would consider a midlife crisis, only one-fourth of the MIDUS respondents said yes. And they defined such events much more loosely than researchers do. Some reported a crisis well before age 40, others well after age 50. And most attributed it not to age but rather to challenging life events (Wethington, 2000 ). Consistent with this view, Elena had considered both a divorce and a new career long before she initiated these changes. In her thirties, she separated from her husband; later she reconciled with him and told him that she desired to return to school, which he firmly opposed. She put her own life on hold because of her daughter’s academic and emotional difficulties and her husband’s resistance.

Another way of exploring midlife questioning is to ask adults about life regrets—attractive opportunities for career or other life-changing activities they did not pursue or lifestyle changes they did not make. In two investigations of women in their early forties, those who acknowledged regret without making life changes, compared to those who modified their lives, reported less favorable psychological well-being and poorer physical health over time (Landman et al., 1995 ; Stewart & Vandewater, 1999 ). The two groups did not differ in social or financial resources available to effect change. Rather, they differed in personality: Those who made changes were higher in confidence and assertiveness.

By late midlife, with less time ahead to make life changes, people’s interpretation of regrets plays a major role in their well-being. Mature, contented adults acknowledge a past characterized by some losses, have thought deeply about them, and feel stronger because of them. At the same time, they are able to disengage from them, investing in current, personally rewarding goals (King & Hicks, 2007 ). Among a sample of several hundred 60- to 65-year-olds diverse in SES, about half expressed at least one regret. Compared to those who had not resolved their disappointments, those who had come to terms with them (accepted and identified some eventual benefits) or had “put the best face on things” (identified benefits but still had some lingering regret) reported better physical health and greater life satisfaction (Torges, Stewart, & Miner-Rubino, 2005 ).

In sum, life evaluation is common during middle age. Most people make changes that are best described as turning points rather than drastic alterations of their lives. Those who cannot modify their life paths often look for the “silver lining” in life’s difficulties (King & Hicks, 2007 ; Wethington, Kessler, & Pixley, 2004 ). The few midlifers who are in crisis typically have had early adulthoods in which gender roles, family pressures, or low income and poverty severely limited their ability to fulfill personal needs and goals, at home or in the wider world.

Stage or Life Events Approach

That crisis and major restructuring in midlife are rare raises, once again, a question we considered in Chapter 14 : Can adult psychosocial changes can be organized into stages, as Erikson’s, Levinson’s, and Vaillant’s theories indicate? A growing number of researchers believe the midadult transition is not stagelike (Freund & Ritter, 2009 ; McCrae & Costa, 2003 ; Srivastava et al., 2003 ). Some regard it as simply an adaptation to normative life events, such as children growing up, reaching the crest of a career, and impending retirement.

Yet recall from earlier chapters that life events are no longer as age-graded as they were in the past. Their timing is so variable that they cannot be the sole cause of midlife change. Furthermore, in several studies, people were asked to trace their thoughts, feelings, attitudes, and hopes during early and middle adulthood. Psychosocial change, in terms of personal disruption followed by reassessment, coincided with both family life cycle events and chronological age. For this reason, most experts regard adaptation during midlife as the combined result of growing older and social experiences (Lachman, 2004 ; Sneed, Whitbourne, & Culang, 2006 ). TAKE A MOMENT… Return to our discussion of generativity and the midlife transition on page 533 , and notice how both factors are involved.

Finally, in describing their lives, the large majority of middle-aged people report troubling moments that prompt new understandings and goals. As we look closely at emotional and social development in middle adulthood, we will see that this period, like others, is characterized by both continuity and change. Debate persists over whether midlife psychosocial changes are stagelike. With this in mind, let’s turn to the diverse inner concerns and outer experiences that contribute to psychological well-being and decision making in midlife.

ASK YOURSELF

REVIEW What personal and cultural forces motivate generativity? Why does it increase and contribute vitally to favorable adjustment in midlife?

CONNECT How might the approach of many middle-aged adults to handling life regrets prevent the occurrence of midlife crises?

APPLY After years of experiencing little personal growth at work, 42-year-old Mel looked for a new job and received an attractive offer in another city. Although he felt torn between leaving close friends and pursuing a long-awaited career opportunity, after several weeks of soul searching, he took the new job. Was Mel’s dilemma a midlife crisis? Why or why not?

REFLECT Think of a middle-aged adult whom you admire. Describe the various ways that individual expresses generativity.

image10 Stability and Change in Self-Concept and Personality

Midlife changes in self-concept and personality reflect growing awareness of a finite lifespan, longer life experience, and generative concerns. Yet certain aspects of personality remain stable, revealing the persistence of individual differences established during earlier periods.

Possible Selves

On a business trip, Jewel found a spare afternoon to visit Trisha. Sitting in a coffee shop, the two women reminisced about the past and thought aloud about the future. “It’s been tough living on my own and building the business,” Jewel said. “What I hope for is to become better at my work, to be more community-oriented, and to stay healthy and available to my friends. Of course, I would rather not grow old alone, but if I don’t find that special person, I suppose I can take comfort in the fact that I’ll never have to face divorce or widowhood.”

Jewel is discussing possible selves, future-oriented representations of what one hopes to become and what one is afraid of becoming. Possible selves are the temporal dimension of self-concept—what the individual is striving for and attempting to avoid. To lifespan researchers, these hopes and fears are just as vital in explaining behavior as people’s views of their current characteristics. Indeed, possible selves may be an especially strong motivator of action in midlife, as adults attach increased meaning to time (Frazier & Hooker, 2006 ). As we age, we may rely less on social comparisons in judging our self-worth and more on temporal comparisons—how well we are doing in relation to what we had planned.

Throughout adulthood, the personality traits people assign to their current selves show considerable stability. A 30-year-old who says he is cooperative, competent, outgoing, or successful is likely to report a similar picture at a later age. But reports of possible selves change greatly. Adults in their early twenties mention many possible selves, and their visions are lofty and idealistic—being “perfectly happy,” “rich and famous,” “healthy throughout life,” and not being “down and out” or “a person who does nothing important.” With age, possible selves become fewer in number and more modest and concrete. Most middle-aged people no longer desire to be the best or the most successful. Instead, they are largely concerned with performance of roles and responsibilities already begun—“being competent at work,” “being a good husband and father,” “putting my children through the colleges of their choice,” “staying healthy,” and not being “a burden to my family” or “without enough money to meet my daily needs” (Bybee & Wells, 2003 ; Cross & Markus, 1991 ; Ryff, 1991 ).

What explains these shifts in possible selves? Because the future no longer holds limitless opportunities, adults preserve mental health by adjusting their hopes and fears. To stay motivated, they must maintain a sense of unachieved possibility, yet they must still manage to feel good about themselves and their lives despite disappointments (Lachman & Bertrand, 2002 ). For example, Jewel no longer desired to be an executive in a large company, as she had in her twenties. Instead, she wanted to grow in her current occupation. And although she feared loneliness in old age, she reminded herself that marriage can lead to equally negative outcomes, such as divorce and widowhood—possibilities that made not having attained an important interpersonal goal easier to bear.

Unlike current self-concept, which is constantly responsive to others’ feedback, possible selves (though influenced by others) can be defined and redefined by the individual, as needed. Consequently, they permit affirmation of the self, even when things are not going well (Bolkan & Hooker, 2012 ). Researchers believe that possible selves may be the key to continued well-being in adulthood, as people revise these future images to achieve a better match between desired and achieved goals. Many studies reveal that the self-esteem of middle-aged and older individuals equals or surpasses that of younger people, perhaps because of the protective role of possible selves (Robins & Trzesniewski, 2005 ).

Self-Acceptance, Autonomy, and Environmental Mastery

An evolving mix of competencies and experiences leads to changes in certain aspects of personality during middle adulthood. In Chapter 15 , we noted that midlife brings gains in expertise and practical problem solving. Middle-aged adults also offer more complex, integrated descriptions of themselves than do younger and older individuals (Labouvie-Vief, 2003 ). Furthermore, midlife is typically a period in which the number of social roles peaks—spouse, parent, worker, and engaged community member. And status at work and in the community typically rises, as adults take advantage of opportunities for leadership and other complex responsibilities (Helson, Soto, & Cate, 2006 ).

· These changes in cognition and breadth of roles undoubtedly contribute to other gains in personal functioning. In research on adults ranging in age from the late teens into the seventies, and in cultures as distinct as the United States and Japan, three qualities increased from early to middle adulthood:

· ● Self-acceptance: More than young adults, middle-aged people acknowledged and accepted both their good and bad qualities and felt positively about themselves and life.

· ● Autonomy: Middle-aged adults saw themselves as less concerned about others’ expectations and evaluations and more concerned with following self-chosen standards.

· ● Environmental mastery: Middle-aged people saw themselves as capable of managing a complex array of tasks easily and effectively (Karasawa et al., 2011 ; Ryff & Keyes, 1995 ).

As these findings indicate, midlife is generally a time of increased comfort with the self, independence, assertiveness, commitment to personal values, and life satisfaction (Helson, Jones, & Kwan, 2002 ; Keyes, Shmotkin, & Ryff, 2002 ; Stone et al., 2010 ). Perhaps because of this rise in overall psychological well-being, middle age is sometimes referred to as “the prime of life.”

At the same time, factors contributing to psychological well-being differ substantially among cohorts, as self-reports gathered from 25- to 65-year-old MIDUS survey respondents reveal (Carr, 2004 ). Among women who were born during the baby-boom years or later, and who thus benefited from the women’s movement, balancing career with family predicted greater self-acceptance and environmental mastery. But also consider that women born before or during World War II who sacrificed career to focus on child rearing—expected of young mothers in the 1950s and 1960s—were similarly advantaged in self-acceptance. Likewise, men who were in step with prevailing social expectations scored higher in well-being. Baby-boom and younger men who modified their work schedules to make room for family responsibilities—who fit their cohort’s image of the “good father”—were more self-accepting. But older men who made this accommodation scored much lower in self-acceptance than those who focused on work and thus conformed to the “good provider” ideal of their times. (See the Biology and Environment box on pages 540 – 541 for additional influences on midlife psychological well-being.)

Notions of happiness, however, vary among cultures. In comparisons of Japanese and Korean adults with same-age U.S. MIDUS participants, the Japanese and Koreans reported lower levels of psychological well-being, largely because they were less willing than the Americans to endorse individualistic traits, such as self-acceptance and autonomy, as characteristic of themselves (Karasawa et al., 2011 ; Keyes & Ryff, 1998b ). Consistent with their collectivist orientation, Japanese and Koreans’ highest well-being scores were on positive relations with others. The Korean participants clarified that they viewed personal fulfillment as achieved through family, especially the success of children. Americans also regarded family relations as relevant to well-being but placed greater emphasis on their own traits and accomplishments than on their children’s.

Coping with Daily Stressors

In Chapter 15 , we discussed the importance of stress management in preventing illness. It is also vital for psychological well-being. In a MIDUS satellite study in which more than 1,000 participants were interviewed on eight consecutive evenings, researchers found an early- to mid-adulthood plateau in frequency of daily stressors, followed by a decline as work and family responsibilities ease and leisure time increases (see Figure 16.2 ) (Almeida & Horn, 2004 ). Women reported more frequent role overload (conflict among roles of employee, spouse, parent, and caregiver of an aging parent) and family-network and child-related stressors, men more work-related stressors, but both genders experienced all varieties. Compared with older people, young and midlife adults also perceived their stressors as more disruptive and unpleasant, perhaps because they often experienced several at once, and many involved financial risks and children.

But recall, also, from Chapter 15 that midlife brings an increase in effective coping strategies. Middle-aged individuals are more likely to identify the positive side of difficult situations, postpone action to permit evaluation of alternatives, anticipate and plan ways to handle future discomforts, and use humor to express ideas and feelings without offending others (Diehl, Coyle, & Labouvie-Vief, 1996 ). Notice how these efforts flexibly draw on both problem-centered and emotion-centered strategies.

image11

FIGURE 16.2 Age-related changes in daily stressors among men and women.

In a MIDUS satellite study, researchers interviewed more than 1,000 adults on eight consecutive evenings. Findings revealed an early- to mid-adulthood plateau, followed by a decline as work and family responsibilities ease and leisure time increases.

(From D. M. Almeida & M. C. Horn, 2004, “Is Daily Life More Stressful During Middle Adulthood?” in O. G. Brim, C. D. Ruff, and R. C. Kessler [Eds.], How Healthy Are We? A National Study of Well-Being at Midlife. Chicago: The University of Chicago Press, p. 438. Adapted by permission of The University of Chicago Press.)

Why might effective coping increase in middle adulthood? Other personality changes seem to support it. Complex, integrated, coherent self-descriptions—which increase in midlife, indicating an improved ability to blend strengths and weaknesses into an organized picture—predict a stronger sense of personal control over outcomes and good coping strategies (Hay & Diehl, 2010 ; Labouvie-Vief & Diehl, 2000 ). Midlife gains in emotional stability and confidence in handling life’s problems may also contribute (Roberts et al., 2007 ; Roberts & Mroczek, 2008 ). These attributes predict work and relationship effectiveness—outcomes that reflect the sophisticated, flexible coping of middle age.

Gender Identity

In her forties and early fifties, Trisha appeared more assertive at work. She spoke out more freely at meetings and took a leadership role when a team of lawyers worked on an especially complex case. She was also more dominant in family relationships, expressing her opinions to her husband and son more readily than she had 10 or 15 years earlier. In contrast, Devin’s sense of empathy and caring became more apparent, and he was less assertive and more accommodating to Trisha’s wishes than before.

Many studies report an increase in “masculine” traits in women and “feminine” traits in men across middle age (Huyck, 1990 ; James et al., 1995 ). Women become more confident, self-sufficient, and forceful, men more emotionally sensitive, caring, considerate, and dependent. These trends appear in cross-sectional and longitudinal research, in people varying in SES, and in diverse cultures—not just Western industrialized nations but also village societies such as the Maya of Guatemala, the Navajo of the United States, and the Druze of the Middle East (Fry, 1985 ; Gutmann, 1977 ; Turner, 1982 ). Consistent with Levinson’s theory, gender identity in midlife becomes more androgynous—a mixture of “masculine” and “feminine” characteristics.

Although the existence of these changes is well-accepted, explanations for them are controversial. A well-known evolutionary view, parental imperative theory , holds that identification with traditional gender roles is maintained during the active parenting years to help ensure the survival of children. Men become more goal-oriented, while women emphasize nurturance (Gutmann & Huyck, 1994 ). After children reach adulthood, parents are free to express the “other-gender” side of their personalities.

Biology and environment What Factors Promote Psychological Well-Being in Midlife?

image12

These yoga students express a sense of purpose and accomplishment. Maintaining an exercise regimen contributes greatly to midlife psychological well-being.

For Trisha and Devin, midlife brought contentment and high life satisfaction. But the road to happiness was rockier for Jewel, Tim, and Elena. What factors contribute to individual differences in psychological well-being at midlife? Consistent with the lifespan perspective, biological, psychological, and social forces are involved, and their effects are interwoven.

Good Health and Exercise

Good health affects energy and zest for life at any age. But during middle and late adulthood, taking steps to improve health and prevent disability becomes a better predictor of psychological well-being. Many studies confirm that engaging in regular exercise—walking, dancing, jogging, or swimming—is more strongly associated with self-rated health and a positive outlook in older than in younger adults (Bherer, 2012 ). Middle-aged people who maintain an exercise regimen are likely to perceive themselves as particularly active for their age and, therefore, to feel a special sense of accomplishment (Netz et al., 2005 ). In addition, physical activity enhances self-efficacy and effective stress management (see page 515 in Chapter 15 ).

Sense of Control and Personal Life Investment

Middle-aged adults who report a high sense of control over events in various aspects of their lives—health, family, and work—also report more favorable psychological well-being. Sense of control contributes further to self-efficacy. It also predicts use of more effective coping strategies, including seeking of social support, and thereby helps sustain a positive outlook in the face of health, family, and work difficulties (Lachman, Neupert, & Agrigoroaei, 2011 ).

Personal life investment—firm commitment to goals and involvement in pursuit of those goals—also adds to mental health and life satisfaction (Staudinger & Bowen, 2010 ). According to Mihaly Csikszentmihalyi, a vital wellspring of happiness is flow—the psychological state of being so engrossed in a demanding, meaningful activity that one loses all sense of time and self-awareness. People describe flow as the height of enjoyment, even as an ecstatic state. The more people experience flow, the more they judge their lives to be gratifying (Nakamura & Csikszentmihalyi, 2009 ). Although flow is common in people engaged in creative endeavors, many others report it—students who love studying, employees who like their jobs, adults involved in challenging leisure pursuits, and parents and grandparents engaged in pleasurable learning activities with children. Flow depends on perseverance and skill at complex endeavors that offer potential for growth. These qualities are well-developed in middle adulthood.

Positive Social Relationships

Developing gratifying social ties is closely linked to midlife psychological well-being. In a survey of college alumni, those who preferred occupational prestige and high income to close friends were twice as likely as other respondents to describe themselves as “fairly” or “very” unhappy (Perkins, 1991 , as cited by Myers, 2000 ).

Supportive relationships, especially with friends and relatives, improve mental health by promoting positive emotions and protecting against stress (Fiori, Antonucci, & Cortina, 2006 ; Powdthavee, 2008 ). Enjoyable social ties can even strengthen the impact of an exercise regimen on well-being. Among an ethnically diverse sample of women using a private gym or an African Caribbean community center, exercising with likeminded companions contributed to their happiness and life satisfaction (Wray, 2007 ). The social side of going to the gym appeared especially important to minority women, who were less concerned with physical-appearance benefits than their Caucasian agemates.

A Good Marriage

Although friendships are important, a good marriage boosts psychological well-being even more. The role of marriage in mental health increases with age, becoming a powerful predictor by late midlife (Marks, Bumpass, & Jun, 2004 ; Marks & Greenfield, 2009 ).

Longitudinal studies tracking people as they move in and out of intimate relationships suggest that marriage actually brings about well-being. For example, when interviews with over 13,000 U.S. adults were repeated five years later, people who remained married reported greater happiness than those who remained single. Those who separated or divorced became less happy, reporting considerable depression (Marks & Lambert, 1998 ). Couples who married for the first time experienced a sharp increase in happiness, those who entered their second marriage a modest increase.

Although not everyone is better off married, the link between marriage and well-being is similar in many nations, suggesting that marriage changes people’s behavior in ways that make them better off (Diener et al., 2000 ; Lansford et al., 2005 ). Married partners monitor each other’s health and offer care in times of illness. They also earn and save more money than single people, and higher income is modestly linked to psychological well-being (Myers, 2000 ; Waite, 1999 ). Furthermore, sexual satisfaction predicts mental health, and married couples have more satisfying sex lives than singles (see Chapter 13 ).

Mastery of Multiple Roles

Finally, success in handling multiple roles—spouse, parent, worker, community volunteer—is linked to psychological well-being. In the MIDUS survey, as role involvement increased, both men and women reported greater environmental mastery, more rewarding social relationships, heightened sense of purpose in life, and more positive emotion. Furthermore, adults who occupied multiple roles and who also reported high control (suggesting effective role management) scored especially high in well-being—an outcome that was stronger for less-educated adults (Ahrens & Ryff, 2006 ). Control over roles may be vital for individuals with lower educational attainment, whose role combinations may be particularly stressful and who have fewer economic resources.

Finally, among nonfamily roles, community volunteering in the latter part of midlife contributes uniquely to psychological well-being (Choi & Kim, 2011 ; Ryff et al., 2012 ). It may do so by strengthening self-efficacy, generativity, and altruism.

But this biological account has been criticized. As we discussed in earlier chapters, parents need both warmth and assertiveness (in the form of firmness and consistency) to rear children effectively. And although children’s departure from the home is related to men’s openness to the “feminine” side of their personalities, the link to a rise in “masculine” traits among women is less apparent (Huyck, 1996 , 1998 ). In longitudinal research, college-educated women in the labor force became more independent by their early forties, regardless of whether they had children; those who were homemakers did not. Women attaining high status at work gained most in dominance, assertiveness, and outspokenness by their early fifties (Helson & Picano, 1990 ; Wink & Helson, 1993 ). Furthermore, cohort effects can contribute to this trend: In one study, middle-aged women of the baby-boom generation—who experienced new career opportunities as a result of the women’s movement—more often described themselves as having masculine and androgynous traits than did older women (Strough et al., 2007 ).

Additional demands of midlife may prompt a more androgynous orientation. For example, among men, a need to enrich a marital relationship after children have departed, along with reduced chances for career advancement, may be involved in the awakening of emotionally sensitive traits. Compared with men, women are far more likely to face economic and social disadvantages. A greater number remain divorced, are widowed, and encounter discrimination in the workplace. Self-reliance and assertiveness are vital for coping with these circumstances.

In sum, androgyny in midlife results from a complex combination of social roles and life conditions. In Chapter 8 , we noted that androgyny predicts high self-esteem. In adulthood, it is also associated with cognitive flexibility, creativity, advanced moral reasoning, and psychosocial maturity (Prager & Bailey, 1985 ; Runco, Cramond, & Pagnani, 2010 ; Waterman & Whitbourne, 1982 ). People who integrate the masculine and feminine sides of their personalities tend to be psychologically healthier, perhaps because they are able to adapt more easily to the challenges of aging.

image13

In middle age, gender identity becomes more androgynous for both sexes. Men tend to show an increase in “feminine” traits, becoming more emotionally sensitive, caring, considerate, and dependent.

Individual Differences in Personality Traits

Although Trisha and Jewel both became more self-assured and assertive in midlife, in other respects they differed. Trisha had always been more organized and hard-working, Jewel more gregarious and fun-loving. Once, the two women traveled together. At the end of each day, Trisha was disappointed if she had not kept to a schedule and visited every tourist attraction. Jewel liked to “play it by ear”—wandering through streets and stopping to talk with shopkeepers and residents.

In previous sections, we considered personality changes common to many middle-aged adults, but stable individual differences also exist. Through factor analysis of self-report ratings, the hundreds of personality traits on which people differ have been reduced to five basic factors, often referred to as the “big five” personality traits: neuroticism, extroversion, openness to experience, agreeableness, and conscientiousness. Table 16.1 provides a description of each. Notice that Trisha is high in conscientiousness, whereas Jewel is high in extroversion.

Longitudinal and cross-sectional studies of U.S. men and women reveal that agreeableness and conscientiousness increase from the teenage years through middle age, whereas neuroticism declines, and extroversion and openness to experience do not change or decrease slightly—changes that reflect “settling down” and greater maturity. Similar trends have been identified in more than fifty countries varying widely in cultural traditions, including Canada, Germany, Italy, Japan, Russia, and South Korea (McCrae & Costa, 2006 ; Roberts, Walton, & Viechtbauer, 2006 ; Schmitt et al., 2007 ; Soto et al., 2011 ; Srivastava et al., 2003 ). The consistency of these cross-cultural findings has led some researchers to conclude that adult personality change is genetically influenced. They note that individual differences in the “big five” traits are large and highly stable: A person who scores high or low at one age is likely to do the same at another, over intervals ranging from 3 to 30 years (McCrae & Costa, 2006 ).

TABlE 16.1 The “Big Five” Personality Traits

TRAIT

DESCRIPTION

Neuroticism

Individuals who are high on this trait are worrying, temperamental, self-pitying, self-conscious, emotional, and vulnerable.

Extroversion

Individuals who are high on this trait are affectionate, talkative, active, fun-loving, and passionate. Individuals who are low are reserved, quiet, passive, sober, and emotionally unreactive.

Openness to experience

Individuals who are high on this trait are imaginative, creative, original, curious, and liberal. Individuals who are low are down-to-earth, uncreative, conventional, uncurious, and conservative.

Agreeableness

Individuals who are high on this trait are soft-hearted, trusting, generous, acquiescent, lenient, and good-natured. Individuals who are low are ruthless, suspicious, stingy, antagonistic, critical, and irritable.

Conscientiousness

Individuals who are high on this trait are conscientious, hard-working, well-organized, punctual, ambitious, and persevering. Individuals who are low are negligent, lazy, disorganized, late, aimless, and nonpersistent.

Source: McCrae, 2011; McCrae & Costa, 2006.

How can there be high stability in personality traits, yet significant changes in aspects of personality discussed earlier? Studies of the “big five” traits include very large samples and typically do not examine the impact of a host of contextual factors—including life events, the social clock, and cultural values—that shape aspirations, goals, and expectations for appropriate behavior (Caspi & Roberts, 2001 ). Look closely at the traits in Table 16.1 , and you will see that they differ from the attributes considered in previous sections: They do not take into account motivations, preferred tasks, and coping styles, nor do they consider how certain aspects of personality, such as masculinity and femininity, are integrated. Theorists concerned with change due to experience focus on how personal needs and life events induce new strategies and goals; their interest is in “the human being as a complex adaptive system” (Block, 1995 , 2011 , p. 19). In contrast, those who emphasize stability due to heredity measure personality traits on which individuals can easily be compared and that are present at any time of life.

To resolve this apparent contradiction, we can think of adults as changing in overall organization and integration of personality but doing so on a foundation of basic, enduring dispositions that support a coherent sense of self as people adapt to changing life circumstances. When more than 2,000 individuals in their forties were asked to reflect on their personalities during the previous six years, 52 percent said they had “stayed the same,” 39 percent said they had “changed a little,” and 9 percent said they had “changed a lot” (Herbst et al., 2000 ). Again, these findings contradict a view of middle adulthood as a period of great turmoil and change. But they also underscore that personality remains an “open system,” responsive to the pressures of life experiences. Indeed, certain midlife personality changes may strengthen trait consistency! Improved self-understanding, self-acceptance, and skill at handling challenging situations may result in less need to modify basic personality dispositions over time.

ASK YOURSELF

REVIEW Summarize personality changes at midlife. How can these changes be reconciled with increasing stability of the “big five” personality traits?

CONNECT List cognitive gains that typically occur during middle adulthood. (See Chapter 15 , pages 518 – 519 and 524 – 525 .) How might they support midlife personality changes?

APPLY Jeff, age 46, suggested to his wife, Julia, that they set aside time once a year to discuss their relationship—both positive aspects and ways to improve. Julia was surprised because Jeff had never before expressed interest in working on their marriage. What midlife developments probably fostered this new concern?

REFLECT List your hoped-for and feared possible selves. Then ask family members in early and middle adulthood to do the same. Are their reports consistent with age-related research findings? Explain.

image14 Relationships at Midlife

The emotional and social changes of midlife take place within a complex web of family relationships and friendships and an intensified personal focus on generative concerns. Although some middle-aged people live alone, the vast majority—87 percent in the United States—live in families, most with a spouse (U.S. Census Bureau, 2012b ). Partly because they have ties to older and younger generations in their families and partly because their friendships are well-established, people tend to have a larger number of close relationships during midlife than at any other period (Antonucci, Akiyama, & Takahashi, 2004 ).

The middle adulthood phase of the family life cycle is often referred to as “launching children and moving on.” In the past, it was called the “empty nest,” but this phrase implies a negative transition, especially for women who have devoted themselves entirely to their children and for whom the end of active parenting can trigger feelings of emptiness and regret. But for most people, middle adulthood is a liberating time, offering a sense of completion and opportunities to strengthen social ties and rekindle interests.

As our discussion in Chapter 14 revealed, increasing numbers of young adults are living at home because of tight job markets and financial challenges, yielding launch–return–relaunch patterns for many middle-aged parents. Still, a declining birthrate and longer life expectancy mean that many contemporary parents do launch children a decade or more before retirement and then turn to other rewarding activities. As adult children depart and marry, middle-aged parents must adapt to new roles of parent-in-law and grandparent. At the same time, they must establish a different type of relationship with their aging parents, who may become ill or infirm and die.

Middle adulthood is marked by the greatest number of exits and entries of family members. Let’s see how ties within and beyond the family change during this time of life.

Marriage and Divorce

Although not all couples are financially comfortable, middle-aged households are well-off economically compared with other age groups. Americans between 45 and 54 have the highest average annual income. And the baby boomers—more of whom have earned college and postgraduate degrees and live in dual-earner families—are financially better off than previous midlife generations (Eggebeen & Sturgeon, 2006 ; U.S. Census Bureau, 2012b ). Partly because of increased education and financial security, the contemporary social view of marriage in midlife is one of expansion and new horizons.

These forces strengthen the need to review and adjust the marital relationship. For Devin and Trisha, this shift was gradual. By middle age, their marriage had permitted satisfaction of family and individual needs, endured many changes, and culminated in deeper feelings of love. Elena’s marriage, in contrast, became more conflict-ridden as her teenage daughter’s problems introduced added strains and as departure of children made marital difficulties more obvious. Tim’s failed marriage revealed yet another pattern. With passing years, the number of problems declined, but so did the love expressed (Rokach, Cohen, & Dreman, 2004 ). As less happened in the relationship, good or bad, the couple had little to keep them together.

As the Biology and Environment box on pages 540 – 541 revealed, marital satisfaction is a strong predictor of midlife psychological well-being. Middle-aged men who have focused only on career often realize the limited nature of their pursuits. At the same time, women may insist on a more gratifying relationship. And children fully engaged in adult roles remind middle-aged parents that they are in the latter part of their lives, prompting many to decide that the time for improving their marriages is now (Berman & Napier, 2000 ).

image15

For many middle-aged couples, having forged a relationship that permits satisfaction of both family and individual needs results in deep feelings of love.

As in early adulthood, divorce is one way of resolving an unsatisfactory marriage in midlife. The divorce rate of U.S. 50-to 65-year-olds has doubled over the past two decades (Brown & Lin, 2012 ). Divorce at any age takes a heavy psychological toll, but midlifers seem to adapt more easily than younger people. A survey of more than 13,000 Americans revealed that following divorce, middle-aged men and women reported less decline in psychological well-being than their younger counterparts (Marks & Lambert, 1998 ). Midlife gains in practical problem solving and effective coping strategies may reduce the stressful impact of divorce.

Because the divorce rate is more than twice as great among remarried couples as among those in first marriages, about half of midlife divorces involve people who have had one or more previous unsuccessful marriages. Highly educated middle-aged adults are more likely to divorce, probably because their more comfortable economic circumstances make it easier to leave an unhappy marriage (Skaff, 2006 ). Nevertheless, for many women, marital breakup—especially when it is repeated—severely reduces standard of living (see page 347 in Chapter 10 ). For this reason, in midlife and earlier, it is a strong contributor to the feminization of poverty —a trend in which women who support themselves or their families have become the majority of the adult population living in poverty, regardless of age and ethnic group. Because of weak public policies safeguarding families (see Chapter 2 ), the gender gap in poverty is higher in the United States than in other Western industrialized nations (U.S. Census Bureau, 2012b ).

What do recently divorced middle-aged people say about why their marriages ended? Women frequently mention communication problems, inequality in the relationship, adultery, gradual distancing, substance abuse, physical and verbal abuse, or their own desire for autonomy. Men also bring up poor communication and sometimes admit that their “workaholic” lifestyle or emotional inattentiveness played a major role in their marital failure. Women are more likely than men to initiate divorce, and those who do fare somewhat better in psychological well-being. Men who initiate a split often already have another romantic involvement to turn to (Rokach, Cohen, & Dreman, 2004 ; Sakraida, 2005 ; Schneller & Arditti, 2004 ).

Longitudinal evidence reveals that middle-aged women who weather divorce successfully tend to become more tolerant, comfortable with uncertainty, nonconforming, and self-reliant in personality—factors believed to be fostered by divorce-forced independence. And both men and women reevaluate what they consider important in a healthy relationship, placing greater weight on equal friendship and less on passionate love than they had the first time. As in earlier periods, divorce represents both a time of trauma and a time of growth (Baum, Rahav, & Sharon, 2005 ; Schneller & Arditti, 2004 ). Little is known about long-term adjustment following divorce among middle-aged men, perhaps because most enter new relationships and remarry within a short time.

Changing Parent–Child Relationships

Parents’ positive relationships with their grown children are the result of a gradual process of “letting go,” starting in childhood, gaining momentum in adolescence, and culminating in children’s independent living. As noted earlier, most parents “launch” adult children sometime in midlife. But because more people are delaying having children to their thirties and even forties (see page 438 in Chapter 13 ), the age at which midlifers experience their children’s departure varies widely. Most parents adjust well; only a minority have difficulty (Mitchell & Lovegreen, 2009 ). Investment in nonparental relationships and roles, children’s characteristics, parents’ marital and economic circumstances, and cultural forces affect the extent to which this transition is expansive and rewarding or sad and distressing.

After their son Mark secured a career-entry job and moved out of the family home permanently, Devin and Trisha felt a twinge of nostalgia combined with a sense of pride in their grown son’s maturity and success. Beyond this, they returned to rewarding careers and community participation and delighted in having more time for each other. Parents who have developed gratifying alternative activities typically welcome their children’s adult status (Mitchell & Lovegreen, 2009 ). A strong work orientation, especially, predicts gains in life satisfaction after children depart from the home (Silverberg, 1996 ).

Wide cultural variations exist in the social clock for children’s departure. Recall from Chapter 13 that many young people from low-SES homes and with cultural traditions of extended-family living do not leave home early. In the Southern European countries of Greece, Italy, and Spain, parents often actively delay their children’s leaving. In Italy, for example, parents believe that moving out without a “justified” reason signifies that something is wrong in the family. Hence, many more Italian young adults reside with their parents until marriage than in other Western nations. At the same time, Italian adults grant their grown children extensive freedom within the parental home (Rusconi, 2004 ). Parent–adult-child relationships are usually positive, making living with parents attractive.

With the end of parent–child coresidence comes a substantial decline in parental authority. Devin and Trisha no longer knew of Mark’s daily comings and goings or expected him to inform them. Nevertheless, Mark telephoned at regular intervals to report on events in his life and seek advice about major decisions. Although the parental role changes, its continuation is important to middle-aged adults. Departure of children is a relatively minor event as long as parent–child contact and affection are sustained (Mitchell & Lovegreen, 2009 ). When it results in little or no communication, parents’ psychological well-being declines.

Whether or not they reside with parents, adolescent and young-adult children who are “off-time” in development—who deviate from parental expectations about how the path to adult responsibilities should unfold—can prompt parental strain (Pillemer & Suitor, 2002 ; Settersten, 2003 ). Consider Elena, whose daughter was doing poorly in her college courses and in danger of not graduating. The need for extensive parental guidance, at a time when she expected her daughter to be more responsible and independent, caused anxiety and unhappiness for Elena, who was ready to reduce time devoted to active parenting.

In one study, researchers asked a large sample of 40-to 60-year-old parents to report on their grown children’s problems and successes along with their own psychological well-being. Consistent with the familiar saying, “parents are only as happy as their least happy child,” having even one problematic child dampened parents’ well-being, but having a successful child did not have a compensating positive effect. The more grown children with problems, the poorer parents’ well-being. In contrast, it took multiple successful grown children to sway parents’ well-being in a favorable direction (Fingerman et al., 2012a ). As with marriages, negative, conflict-ridden experiences with grown children are particularly salient, profoundly affecting midlife parents’ psychological states.

Throughout middle adulthood, parents continue to give more assistance to children than they receive, especially while children are unmarried or when they face difficulties, such as marital breakup or unemployment (Ploeg et al., 2004 ; Zarit & Eggebeen, 2002 ). Support in Western countries typically flows “downstream”: Although ethnic variations exist, most middle-aged parents provide more financial, practical, emotional, and social support to their offspring than to their aging parents, unless a parent has an urgent need (declining health or other crises) (Fingerman & Birditt, 2011 ; Fingerman et al., 2011a ). In explaining their generous support of adult children, parents usually mention the importance of the relationship. And providing adult children with assistance enhances midlife psychological well-being (Marks & Greenfield, 2009 ). Clearly, middle-aged adults remain invested in their adult children’s development and continue to reap deep personal rewards from the parental role.

When children marry, parents must adjust to an enlarged family network that includes in-laws. Difficulties occur when parents do not approve of their child’s partner or when the young couple adopts a way of life inconsistent with parents’ values. Parents who take steps to forge a positive tie with a future daughter- or son-in-law generally experience a closer relationship after the couple marries (Fingerman et al., 2012b ). And when warm, supportive relationships endure, intimacy between parents and children increases over the adult years, with great benefits for parents’ life satisfaction (Ryff, Singer, & Seltzer, 2002 ). Members of the middle generation, especially mothers, usually take on the role of kinkeeper, gathering the family for celebrations and making sure everyone stays in touch.

Parents of adult children expect a mature relationship, marked by tranquility and contentment. Yet many factors—on both the child’s and the parent’s side—affect whether that goal is achieved. Applying What We Know on page 546 suggests ways middle-aged parents can increase the chances that bonds with adult children will be loving and rewarding and serve as contexts for personal growth.

Grandparenthood

Two years after Mark married, Devin and Trisha were thrilled to learn that a granddaughter was on the way. Although the stereotypical image of grandparents as elderly persists, today the average age of becoming a grandparent is 50 years for American women, 52 for American men (Legacy Project, 2012 ). A longer life expectancy means that many adults will spend one-third or more of their lifespan in the grandparent role.

Meanings of Grandparenthood.

Middle-aged adults typically rate grandparenthood as highly important, following closely behind the roles of parent and spouse but ahead of worker, son or daughter, and sibling (Reitzes & Mutran, 2002 ). Why did Trisha and Devin, like many others their age, greet the announcement of a grandchild with such enthusiasm? Most people experience grandparenthood as a significant milestone, mentioning one or more of the following gratifications:

· ● Valued elder—being perceived as a wise, helpful person

· ● Immortality through descendants—leaving behind not just one but two generations after death

· ● Reinvolvement with personal past—being able to pass family history and values to a new generation

· ● Indulgence—having fun with children without major child-rearing responsibilities (AARP, 2002 ; Hebblethwaite & Norris, 2011 )

Applying What We Know Ways Middle-Aged Parents Can Promote Positive Ties with Their Adult Children

Suggestion

Description

Emphasize positive communication.

Let adult children and their intimate partners know of your respect, support, and interest. This not only communicates affection but also permits conflict to be handled in a constructive context.

Avoid unnecessary comments that are a holdover from childhood.

Adult children, like younger children, appreciate an age-appropriate relationship. Comments that have to do with safety, eating, and self-care (“Be careful on the freeway,” “Don’t eat those foods,” “Make sure you wear a sweater—it’s cold out today”) annoy adult children and can stifle communication.

Accept the possibility that some cultural values and practices and aspects of lifestyle will be modified in the next generation.

In constructing a personal identity, most adult children have gone through a process of evaluating the meaning of cultural values and practices for their own lives. Traditions and lifestyles cannot be imposed on adult children.

When an adult child encounters difficulties, resist the urge to “fix” things.

Accept the fact that no meaningful change can take place without the willing cooperation of the adult child. Stepping in and taking over communicates a lack of confidence and respect. Find out whether the adult child wants your help, advice, and decision-making skills.

Be clear about your own needs and preferences.

When it is difficult to arrange for a visit, babysit, or provide other assistance, say so and negotiate a reasonable compromise rather than letting resentment build.

Grandparent–Grandchild Relationships.

Grandparents’ styles of relating to grandchildren vary as widely as the meanings they derive from their new role. The grandparent’s and grandchild’s age and sex make a difference. When their granddaughter was young, Trisha and Devin enjoyed an affectionate, playful relationship with her. As she got older, she looked to them for information and advice in addition to warmth and caring. By the time their granddaughter reached adolescence, Trisha and Devin had become role models, family historians, and conveyers of social, vocational, and religious values.

Living nearby is the strongest predictor of frequent, face-to-face interaction with young grandchildren. Despite high family mobility in Western industrialized nations, most grandparents live close enough to at least one grandchild to enable regular visits. But because time and resources are limited, number of “grandchild sets” (households with grandchildren) reduces grandparent visits (Uhlenberg & Hammill, 1998 ). A strong desire to affect the development of grandchildren can motivate grandparents’ involvement. As grandchildren get older, distance becomes less influential and relationship quality more so: The extent to which adolescent or young-adult grandchildren believe their grandparent values contact is a good predictor of a close bond (Brussoni & Boon, 1998 ).

image16

Emotional and Social Development in Middle Adulthood homework help

Many grandparents derive great joy from an affectionate, playful relationship with young grandchildren. As this grandchild gets older, he may look to his grandfather for advice, as a role model, and for family history in addition to warmth and caring.

© BLUE JEAN IMAGES/ALAMY

As Figure 16.3 shows, maternal grandmothers report more frequent visits with grandchildren than do paternal grandmothers, who are slightly advantaged over both maternal and paternal grandfathers (Uhlenberg & Hammill, 1998 ). Typically, relationships are closer between grandparents and grandchildren of the same sex and, especially, between maternal grandmothers and granddaughters—a pattern found in many countries (Brown & Rodin, 2004 ). Grandmothers also report higher satisfaction with the grandparent role than grandfathers, perhaps because grandmothers are more likely to participate in recreational, religious, and family activities with grandchildren (Reitzes & Mutran, 2004 ; Silverstein & Marenco, 2001 ). The grandparent role may be a vital means through which women satisfy their kinkeeping function.

SES and ethnicity also influence grandparent–grandchild ties. In higher-income families, where the grandparent role is not central to family maintenance and survival, it is fairly unstructured and takes many forms. In low-income families, by contrast, grandparents often perform essential activities. For example, many single parents live with their families of origin and depend on grandparents’ financial and caregiving assistance to reduce the impact of poverty. Compared with grandchildren in intact families, grandchildren in single-parent and stepparent families report engaging in more diverse, higher-quality activities with their grandparents (Kennedy & Kennedy, 1993 ). As children experience the stress of family transition, bonds with grandparents take on increasing importance.

image17

FIGURE 16.3 Influence of grandparent sex and lineage on frequent visiting of grandchildren.

When a nationally representative sample of 4,600 U.S. grandparents were asked how often they visited a particular set of grandchildren, maternal grandmothers were especially likely to report visiting frequently (at least once a week). Paternal grandmothers slightly exceeded both maternal and paternal grandfathers.

(From P. Uhlenberg & B. G. Hammill, 1998, “Frequency of Grandparent Contact with Grandchild Sets: Six Factors That Make a Difference,” Gerontologist, 38, p. 281. Copyright © 1998 The Gerontological Society of America. Reprinted by permission of Oxford University Press and Peter Uhlenberg.)

In some cultures, grandparents are absorbed into an extended-family household and become actively involved in child rearing. When a Chinese, Korean, or Mexican-American maternal grandmother is a homemaker, she is the preferred caregiver while parents of young children are at work (Kamo, 1998 ; Williams & Torrez, 1998 ). Similarly, involvement in child care is high among Native-American grandparents. In the absence of a biological grandparent, an unrelated aging adult may be integrated into the family to serve as a mentor and disciplinarian for children (Werner, 1991 ). (See Chapter 2 , page 66 , for a description of the grandmother’s role in the African-American extended family.)

Increasingly, grandparents have stepped in as primary caregivers in the face of serious family problems. As the Social Issues: Health box on page 548 reveals, a rising number of American children live apart from their parents in grandparent-headed households. Despite their willingness to help and their competence at child rearing, grandparents who take full responsibility for young children experience considerable emotional and financial strain. They need more assistance from community and government agencies than is currently available.

Because parents usually serve as gatekeepers of grandparents’ contact with grandchildren, relationships between grandparents and their daughter-in-law or son-in-law strongly affect the closeness of grandparent–grandchild ties. A positive bond with a daughter-in-law seems particularly important in the relationship between grandparents and their son’s children (Fingerman, 2004 ). And after a marital breakup, grandparents who are related to the custodial parent (typically the mother) have more frequent contact with grandchildren.

When family relationships are positive, grandparenthood provides an important means of fulfilling personal and societal needs in midlife and beyond. Typically, grandparents are a frequent source of pleasure, support, and knowledge for children, adolescents, and young adults. They also provide the young with firsthand experience in how older people think and function. In return, grandchildren become deeply attached to grandparents and keep them abreast of social change. Clearly, grand-parenthood is a vital context for sharing between generations.

Middle-Aged Children and Their Aging Parents

The percentage of middle-aged Americans with living parents has risen dramatically—from 10 percent in 1900 to over 50 percent in the first decade of the twenty-first century (U.S. Census Bureau, 2012b ). A longer life expectancy means that adult children and their parents are increasingly likely to grow old together. What are middle-aged children’s relationships with their aging parents like? And how does life change for adult children when an aging parent’s health declines?

Frequency and Quality of Contact.

A widespread myth is that adults of past generations were more devoted to their aging parents than are today’s adults. Although adult children spend less time in physical proximity to their parents, the reason is not neglect or isolation. Because of a desire to be independent, made possible by gains in health and financial security, fewer aging adults live with younger generations now than in the past. Nevertheless, approximately two-thirds of older adults in the United States live close to at least one of their children, and frequency of contact is high through both visits and telephone calls (U.S. Census Bureau, 2012b ). Proximity increases with age: Aging adults who move usually do so in the direction of kin, and younger people tend to move in the direction of their aging parents.

Middle age is a time when adults reassess relationships with their parents, just as they rethink other close ties. Many adult children become more appreciative of their parents’ strengths and generosity and mention positive changes in the quality of the relationship, even after parents show physical declines. A warm, enjoyable relationship contributes to both parent and adult-child well-being (Fingerman et al., 2007 , 2008 ; Pudrovska, 2009 ). Trisha, for example, felt closer to her parents and often asked them to tell her more about their earlier lives.

Social Issues: Health Grandparents Rearing Grandchildren: The Skipped-Generation Family

image18

A custodial grandmother helps her 8-year-old granddaughter with homework. Although grandparents usually assume the parenting role under highly stressful circumstances, most find compensating rewards in rearing grandchildren.

Nearly 2.4 million U.S. children—4 to 5 percent of the child population—live with grandparents but apart from parents, in skipped-generation families (U.S. Census Bureau, 2012b ). The number of grandparents rearing grandchildren has increased over the past two decades. The arrangement occurs in all ethnic groups, though more often in African-American, Hispanic, and Native-American families than in Caucasian families. Although grandparent caregivers are more likely to be women than men, many grandfathers participate (Fuller-Thomson & Minkler, 2005 , 2007 ; Minkler & Fuller-Thomson, 2005 ). Grandparents generally step in when parents’ troubled lives—as a result of substance abuse, child abuse and neglect, family violence, or physical or mental illness—threaten children’s well-being (Langosch, 2012 ). Often these families take in two or more children.

As a result, grandparents usually assume the parenting role under highly stressful life circumstances. Unfavorable child-rearing experiences have left their mark on the children, who show high rates of learning difficulties, depression, and antisocial behavior. Absent parents’ adjustment difficulties strain family relationships. Parents may interfere by violating the grandparents’ behavioral limits, taking grandchildren away without permission, or making promises to children that they do not keep. These youngsters also introduce financial burdens into households that often are already low-income (Mills, Gomez-Smith, & De Leon, 2005 ; Williamson, Softas-Nall, & Miller, 2003 ). All these factors heighten grandparents’ emotional distress.

Grandparents struggle with daily dilemmas—wanting to be grandparents, not parents; wanting the parent to be present in the child’s life but fearing for the child’s well-being if the parent returns and does not provide good care (Templeton, 2011 ). And grandparent caregivers, at a time when they anticipated having more time for spouses, friends, and leisure, instead have less. Many report feeling emotionally drained, depressed, and worried about what will happen to the children if their own health fails (Hayslip & Kaminski, 2005 ; Langosch, 2012 ). Some families are extremely burdened. Native-American care-giving grandparents are especially likely to be unemployed, to have a disability, to be caring for several grandchildren, and to be living in extreme poverty (Fuller-Thomson & Minkler, 2005 ).

Despite great hardship, these grandparents seem to realize their widespread image as “silent saviors,” often forging close emotional bonds with their grandchildren and using effective child-rearing practices (Fuller-Thomson & Minkler, 2000 ; Gibson, 2005 ). Compared with children in divorced, single-parent families, blended families, or foster families, children reared by grandparents fare better in adjustment (Rubin et al., 2008 ; Solomon & Marx, 1995 ).

Skipped-generation families have a tremendous need for social and financial support and intervention services for troubled children. Custodial grandparents describe support groups—both for themselves and for their grandchildren—as especially helpful, yet only a minority make use of such interventions (Smith, Rodriguez, & Palmieri, 2010 ). This suggests that grandparents need special help in finding out about and accessing support services.

Although their everyday lives are often stressful, caregiving grandparents—even those rearing children with serious problems—report as much fulfillment in the grandparent role as typical grandparents do (Hayslip et al., 2002 ). The warmer the grandparent–grandchild bond, the greater grandparents’ long-term life satisfaction (Goodman, 2012 ). Many grandparents mention joy from sharing children’s lives and feelings of pride at children’s progress, which help compensate for difficult circumstances. And some grandparents view the rearing of grandchildren as a “second chance”—an opportunity to make up for earlier, unfavorable parenting experiences and “do it right” (Dolbin-MacNab, 2006 ).

Research indicates that middle-aged daughters forge closer, more supportive relationships with aging parents, especially mothers, than do middle-aged sons (Fingerman, 2003 ). But this gender difference may be declining. Sons report closer ties and greater assistance to aging parents in recent than in previous studies (Fingerman et al., 2007 , 2008 ). Changing gender roles are likely responsible. Because the majority of contemporary middle-aged women are employed, they face many competing demands on their time and energy. Consequently, men are becoming more involved in family responsibilities, including with aging parents (Fingerman & Birditt, 2011 ). Despite this shift, women’s investment continues to exceed men’s.

image19

In midlife, many adults develop warmer, more supportive relationships with their aging parents. At a birthday party for her mother, this daughter expresses love and appreciation for her mother’s strengths and generosity.

In collectivist cultures, older adults most often live with their married children. For example, traditionally, Chinese, Japanese, and Korean seniors moved in with a son and his wife and children; today, many live with a daughter and her family, too. This tradition of coresidence, however, is declining in some parts of Asia and in the United States, as more Asian and Asian-American aging adults choose to live on their own (Davey & Takagi, 2013 ; Zhan & Montgomery, 2003 ; Zhang, 2004 ). In African-American and Hispanic families as well, coresidence is common. Regardless of whether coresidence and daily contact are typical, relationship quality usually reflects patterns established earlier: Positive parent–child ties generally remain so, as do conflict-ridden interactions.

Help exchanged between adult children and their aging parents is responsive to past and current family circumstances. The more positive the history of the parent–child tie, the more help given and received. Also, aging parents give more help to unmarried adult children and to those with disabilities. Similarly, adult children give more to elderly parents who are widowed or in poor health—usually emotional support and practical help, less often financial assistance. At the same time, middle-aged parents do what they can to maximize the overall quantity of help offered, as needed: While continuing to provide generous assistance to their children because of the priority placed on the parent–child tie (see page 545 ), middle-aged adults augment the aid they give to elderly parents as parental health problems increase (Kunemund, Motel-Klingebiel, & Kohli, 2005 ; Stephens et al., 2009 ).

Even when parent–child relationships have been emotionally distant, adult children offer more support as parents age, out of a sense of altruism and family duty (Silverstein et al., 2002 ). And although the baby-boom generation is often described as self-absorbed, baby-boom midlifers actually express a stronger commitment to caring for their aging parents than the preceding middle-aged generation (Gans & Silverstein, 2006 ).

In sum, as long as multiple roles are manageable and the experiences within each are high in quality, midlife intergenerational assistance as family members (aging parents) have increased needs is best characterized as resource expansion rather than as merely conflicting demands that inevitably drain energy and detract from psychological well-being (Grundy & Henretta, 2006 ; Stephens et al., 2009 ). Recall from the Biology and Environment box on pages 540 – 541 that midlifers derive great personal benefits from successfully managing multiple roles. Their enhanced self-esteem, mastery, and sense of meaning and purpose expand their motivation and energy to handle added family-role demands, from which they reap additional personal rewards.

Caring for Aging Parents.

About 25 percent of U.S. adult children provide unpaid care to an aging adult (MetLife, 2011 ). The burden of caring for aging parents can be great. In Chapter 2 , we noted that as birthrates have declined, the family structure has become increasingly “top-heavy,” with more generations alive but fewer younger members. Consequently, more than one older family member is likely to need assistance, with fewer younger adults available to provide it.

The term sandwich generation is widely used to refer to the idea that middle-aged adults must care for multiple generations above and below them at the same time (Riley & Bowen, 2005 ). Although only a minority of contemporary middle-aged adults who care for aging parents have children younger than age 18 at home, many are providing assistance to young-adult children and to grandchildren—obligations that, when combined with work and community responsibilities, can lead middle-aged caregivers to feel “sandwiched,” or squeezed, between the pressures of older and younger generations. As more baby boomers move into late adulthood and as their adult children continue to delay childbearing, the number of midlifers who are working, rearing young children, and caring for aging parents will increase.

Middle-aged adults living far from aging parents who are in poor health often substitute financial help for direct care, if they have the means. But when parents live nearby and have no spouse to meet their needs, adult children usually engage in direct care. Regardless of family income level, African-American, Asian-American, and Hispanic adults give aging parents more direct care and financial help than Caucasian-American adults do (Shuey & Hardy, 2003 ). Compared with their white counterparts, African Americans and Hispanics express a stronger sense of obligation, and find it more personally rewarding, to support their aging parents (Fingerman et al., 2011b ; Swartz, 2009 ). And African Americans often draw on close, family-like relationships with friends and neighbors for caregiving assistance.

In all ethnic groups, responsibility for providing care to aging parents falls more on daughters than on sons. Why are women usually the principal caregivers? Families turn to the person who seems most available—living nearby and with fewer commitments that might interfere with the ability to assist. These unstated rules, in addition to parents’ preference for same-sex caregivers (aging mothers live longer), lead more women to fill the role (see Figure 16.4 ). Daughters also feel more obligated than sons to care for aging parents (Gans & Silverstein, 2006 ; Stein, 2009 ). And although couples strive to be fair to both sides of the family, they tend to provide more direct care for the wife’s parents. This bias, however, is weaker in ethnic minority families and is nonexistent in Asian nations where cultural norms specify that daughters-in-law provide care to their husband’s parents (Shuey & Hardy, 2003 ; Zhan & Montgomery, 2003 ).

image20

Caring for an aging parent with a chronic illness or disability is highly stressful. But social support reduces physical and emotional strain, enabling adult children to find satisfactions and rewards in tending to parents’ needs.

As Figure 16.4 shows, nearly one-fourth of American working women are caregivers; others quit their jobs to provide care. And the time they devote to caring for a disabled aging parent is substantial, averaging 10 to 20 hours per week (Metlife, 2011 ; Takamura & Williams, 2004 ). Nevertheless, men—although doing less than women—do contribute. In one investigation, employed men spent an average of 7½ hours per week caring for parents or parents-in-law (Neal & Hammer, 2007 ). Tim, for example, looked in on his father, a recent stroke victim, every evening, reading to him, running errands, making household repairs, and taking care of finances. His sister, however, provided more hands-on care—cooking, feeding, bathing, managing medication, and doing laundry. The care sons and daughters provide tends to be divided along gender-role lines. About 10 percent of the time—generally when no other family member can do so—sons become primary caregivers, heavily involved in basic-care tasks (Harris, 1998 ; Pinquart & Sörensen, 2006 ).

As adults move from early to later middle age, the sex difference in parental caregiving declines. Perhaps as men reduce their vocational commitments and feel less need to conform to a “masculine” gender role, they grow more able and willing to provide basic care (Marks, 1996 ; MetLife, 2011 ). At the same time, parental caregiving may contribute to men’s greater openness to the “feminine” side of their personalities. A man who cared for his mother, severely impaired by Alzheimer’s disease, commented on how the experience altered his outlook: “It was so difficult to do these tasks; things a man, a son, is not supposed to do. I have definitely modified my views on conventional expectations” (Hirsch, 1996 , p. 112).

Although most adult children help willingly, caring for a chronically ill or disabled parent is highly stressful. Over time, the parent usually gets worse, and the caregiving task escalates. As Tim explained to Devin and Trisha, “One of the hardest aspects is the emotional strain of seeing my father’s physical and mental decline up close.”

Caregivers who share a household with ill parents—about 23 percent of U.S. adult children—experience the most stress. When a parent and child who have lived separately for years must move in together, conflicts generally arise over routines and lifestyles. But the greatest source of stress is problem behavior, especially for caregivers of parents who have deteriorated mentally (Alzheimer’s Association, 2012b ). Tim’s sister reported that their father would wake during the night, ask repetitive questions, follow her around the house, and become agitated and combative.

image21

FIGURE 16.4 Baby boomers, by work status and gender, who provide basic personal care to an aging parent in poor health.

A survey of a nationally representative sample of 1,100 U.S. men and women over age 50 with at least one parent living revealed that more nonworking than working adults engaged in basic personal care (assistance with such activities as dressing, feeding, and bathing). Regardless of work status, many more women than men were caregivers.

(Adapted from The MetLife Study of Caregiving Costs to Working Caregivers: Double Jeopardy for Baby Boomers Caring for Their Parents, June 2011, Figure 3. Reprinted by permission of The MetLife Mature Market Institute, New York, NY.)

Applying What We Know Relieving the Stress of Caring for an Aging Parent

Strategy

Description

Use effective coping strategies.

Emotional and Social Development in Middle Adulthood homework help

Use problem-centered coping to manage the parent’s behavior and caregiving tasks. Delegate responsibilities to other family members, seek assistance from friends and neighbors, and recognize the parent’s limits while calling on capacities the parent does have. Use emotion-centered coping to reinterpret the situation in a positive way, such as emphasizing the opportunity it offers for personal growth and for giving to parents in the last years of their lives. Avoid denial of anger, depression, and anxiety in response to the caregiving burden, which heightens stress.

Seek social support.

Confide in family members and friends about the stress of caregiving, seeking their encouragement and help. So far as possible, avoid quitting work to care for an ill parent; doing so is associated with social isolation and loss of financial resources.

Make use of community resources.

Contact community organizations to seek information and assistance, in the form of caregiver support groups, in-home respite help, home-delivered meals, transportation, and adult day care.

Press for workplace and public policies that relieve the emotional and financial burdens of caring for an aging parent.

Encourage your employer to provide care benefits, such as flexible work hours and employment leave for caregiving. Communicate with lawmakers and other citizens about the need for additional government funding to help pay for caregiving. Emphasize the need for improved health insurance plans that reduce the financial strain of caring for an aging parent on middle- and low-income families.

Parental caregiving often has emotional, physical, and financial consequences. It leads to role overload, high job absenteeism, exhaustion, inability to concentrate, feelings of hostility, anxiety about aging, and high rates of depression, with women more profoundly affected than men (Neal & Hammer, 2007 ; Pinquart & Sörensen, 2006 ). Caregivers who must reduce their employment hours or leave the labor force to provide care (mostly women) face not just lost wages but also diminished retirement benefits. Despite having more time to care for an ill parent, women who quit work fare especially poorly in adjustment, probably because of social isolation and financial strain (Bookman & Kimbrel, 2011 ). Positive experiences at work can actually reduce the stress of parental care as caregivers bring a favorable self-evaluation and a positive mood home with them.

In cultures and subcultures where adult children feel an especially strong sense of obligation to care for aging parents, the emotional toll is also high (Knight & Sayegh, 2010 ). In research on Korean, Korean-American, and Caucasian-American caregivers of parents with mental disabilities, the Koreans and Korean Americans reported higher levels of family obligation and care burden—and also higher levels of anxiety and depression—than the Caucasian Americans (Lee & Farran, 2004 ; Youn et al., 1999 ). And among African-American care-givers, women who strongly endorsed cultural reasons for providing care (“It’s what my people have always done”) fared less well in mental health two years later than women who moderately endorsed cultural reasons (Dilworth-Anderson, Goodwin, & Williams, 2004 ).

Social support is highly effective in reducing caregiver stress. Tim’s encouragement, assistance, and willingness to listen helped his sister cope with in-home care of their father so that she could find satisfactions in it. When caregiving becomes a team effort with multiple family members trading off, care-givers cope more effectively. Under these conditions, despite being demanding and stressful, it can enhance psychological well-being (Roberto & Jarrott, 2008 ). Adult children feel gratified at having helped and gain in self-understanding, problem solving, and sense of competence.

LOOK AND LISTEN

Ask a middle-aged adult caring for an aging parent in declining health to describe both the stressful and rewarding aspects of caregiving. What strategies does he or she use to reduce stress? To what extent does the caregiver share caregiving burdens with family members and enlist the support of community organizations?

In Denmark, Sweden, and Japan, a government-sponsored home helper system eases the burden of parental care by making specially trained nonfamily caregivers available, based on seniors’ needs (Saito, Auestad, & Waerness, 2010 ). In the United States, in-home care by a nonfamily caregiver is too costly for most families; only 10 to 20 percent arrange it (Family Caregiver Alliance, 2009 ). And unless they must, few people want to place their parents in formal care, such as nursing homes, which also are expensive. Applying What We Know above summarizes ways to relieve the stress of caring for an aging parent—at the individual, family, community, and societal levels. We will address additional care options, along with interventions for caregivers, in Chapter 17 .

Siblings

As Tim’s relationship with his sister reveals, siblings are ideally suited to provide social support. Nevertheless, a survey of a large sample of ethnically diverse Americans revealed that sibling contact and support decline from early to middle adulthood, rebounding only after age 70 for siblings living near each other (White, 2001 ). Decreased midlife contact is probably due to the demands of middle-aged adults’ diverse roles. However, most adult siblings report getting together or talking on the phone at least monthly (Antonucci, Akiyama, & Merline, 2002 ).

Despite reduced contact, many siblings feel closer in mid-life, often in response to major life events (Stewart et al., 2001 ). Launching and marriage of children seem to prompt siblings to think more about each other. As Tim commented, “It helped our relationship when my sister’s children were out of the house and married. I’m sure she cared about me. I think she just didn’t have time!” When a parent becomes seriously ill, brothers and sisters who previously had little to do with one another may find themselves in touch about parental care. And when parents die, adult children realize they have become the oldest generation and must look to each other to sustain family ties.

Not all sibling bonds improve, of course. Recall Trisha’s negative encounters with her sister, Dottie (see page 513 in Chapter 15 ). Dottie’s difficult temperament had made her hard to get along with since childhood, and her temper flared when their father died and problems arose over family finances. Large inequities in division of labor in parental caregiving can also unleash intense sibling conflict (Silverstein & Giarrusso, 2010 ). As siblings grow older, good relationships often get better and poor relationships get worse.

As in early adulthood, sister–sister relationships are closer than sister–brother and brother–brother ties, a difference apparent in many industrialized nations (Cicirelli, 1995 ; Fowler, 2009 ). But a comparison of middle-aged men of the baby-boom generation with those of the preceding cohort revealed warmer, more expressive ties between baby-boom brothers (Bedford & Avioli, 2006 ). A contributing factor may be baby boomers’ more flexible gender-role attitudes.

image22

These brothers, both in their fifties, express their mutual affection at a family reunion. Even when they have only limited contact, siblings often feel closer in midlife.

In industrialized nations, sibling relationships are voluntary. In village societies, they are generally involuntary and basic to family functioning. For example, among Asian Pacific Islanders, family social life is organized around strong brother–sister attachments. A brother–sister pair is often treated as a unit in exchange marriages with another family. After marriage, brothers are expected to protect sisters, and sisters serve as spiritual mentors to brothers. Families not only include biological siblings but bestow on other relatives, such as cousins, the status of brother or sister, creating an unusually large network of lifelong sibling support (Cicirelli, 1995 ). Cultural norms reduce sibling conflict, thereby ensuring family cooperation. In industrialized nations, promoting positive sibling ties in childhood is vital for warm sibling bonds in later years.

Friendships

As family responsibilities declined in middle age, Devin found he had more time to spend with friends. On Friday afternoons, he met several male friends at a coffee house, and they chatted for a couple of hours. But most of Devin’s friendships were couple-based—relationships he shared with Trisha. Compared with Devin, Trisha more often got together with friends on her own.

Middle-aged friendships reflect the same trends discussed in Chapter 14 . At all ages, men’s friendships are less intimate than women’s. Men tend to talk about sports, politics, and business, whereas women focus on feelings and life problems. Women report a greater number of close friends and say they both receive and provide their friends with more emotional support (Antonucci, Akiyama, & Takahashi, 2004 ).

Over the past decade, the average number of friendships rose among U.S. midlifers, perhaps because of ease of keeping in touch through social media (Wang & Wellman, 2010 ). Though falling short of young adults’ use, connecting regularly with friends through Facebook or other social networking sites has risen rapidly among middle-aged adults (see Figure 16.5 ) (Brenner, 2013 ; Hampton et al., 2011 ). As in early adulthood, women are more active users. And users have more offline close relationships, sometimes using Facebook to revive “dormant” friendships.

Still, for both sexes, number of friends declines from middle to late adulthood, probably because people become less willing to invest in nonfamily ties unless they are very rewarding. As selectivity of friendship increases, older adults try harder to get along with friends (Antonucci & Akiyama, 1995 ). Having chosen a friend, middle-aged people attach great value to the relationship and take extra steps to protect it.

LOOK AND LISTEN

Ask a middle-aged couple you know well to describe the number and quality of their friendships today compared with their friendships in early adulthood. Does their report match research findings? Explain.

By midlife, family relationships and friendships support different aspects of psychological well-being. Family ties protect against serious threats and losses, offering security within a long-term timeframe. In contrast, friendships serve as current sources of pleasure and satisfaction, with women benefiting somewhat more than men (Levitt & Cici-Gokaltun, 2011 ). As middle-aged couples renew their sense of companionship, they may combine the best of family and friendship.

image23

FIGURE 16.5 Gains in use of social networking sites by age group from 2005 to 2012.

Repeated surveys of large representative samples of U.S. adults who use the Internet revealed that social networking site use increased substantially for all age groups. Though not as avid users as young adults, most middle-aged adults use social networking sites, primarily Facebook.

(From J. Brenner, 2013, “Pew Internet: Social Networking.” Pew Research Center’s Internet & American Life Project, Washington, D.C. February 14, 2013, www.pewinternet.org . Adapted by permission.)

ASK YOURSELF

REVIEW How do age, sex, proximity, and culture affect grandparent–grandchild ties?

CONNECT Cite evidence that early family relationships affect middle-aged adults’ bonds with adult children, aging parents, and siblings.

APPLY Raylene and her brother Walter live in the same city as their aging mother, Elsie. When Elsie could no longer live independently, Raylene took primary responsibility for her care. What factors probably contributed to Raylene’s involvement in caregiving and Walter’s lesser role?

REFLECT Ask one of your parents for his or her view of how the parent–child relationship changed as you transitioned to new adult roles, such as college student, career-entry worker, married partner, or parent. Do you agree?

image24 Vocational Life

As we have seen, the midlife transition typically involves vocational adjustments. For Devin, it resulted in a move up the career ladder to a demanding administrative post as college dean. Trisha reoriented her career from a large to a small law firm, where she felt her efforts were appreciated. Recall from Chapter 15 that after her oldest child left home, Anya earned a college degree and entered the work force for the first time. Jewel strengthened her commitment to an already successful business, while Elena changed careers. Finally, Tim reduced his career obligations as he prepared for retirement.

Work continues to be a salient aspect of identity and self-esteem in middle adulthood. More so than in earlier or later years, people attempt to increase the personal meaning and self-direction of their vocational lives. At the same time, certain aspects of job performance improve. Middle-aged employees have lower rates of absenteeism, turnover, and accidents. They are also more effective workplace citizens—more often helping colleagues and trying to improve group performance and less often complaining about trivial issues. And because of their greater knowledge and experience, their work productivity typically equals or exceeds that of younger workers (Ng & Feldman, 2008 ). Consequently, an older employee ought to be as valuable as a younger employee, and possibly more so.

The large tide of baby boomers currently moving through midlife and (as we will see in Chapter 18 ) the desire of most to work longer than the previous generation means that the number of older workers will rise dramatically over the next few decades (Leonesio et al., 2012 ). Yet a favorable transition from adult worker to older worker is hindered by negative stereotypes of aging—incorrect assumptions of limited learning capacity, slower decision making, and resistance to change and supervision (Posthuma & Campion, 2009 ). Furthermore, gender discrimination continues to restrict the career attainments of many women. Let’s take a close look at middle-aged work life.

Job Satisfaction

Job satisfaction has both psychological and economic significance. If people are dissatisfied at work, the consequences include absenteeism, turnover, grievances, and strikes, all of which are costly to employers.

Research shows that job satisfaction increases in midlife in diverse nations and at all occupational levels, from executives to hourly workers (see Figure 16.6 on page 554 ). The relationship is weaker for women than for men, probably because women’s reduced chances for advancement result in a sense of unfairness. It is also weaker for blue-collar than for white-collar workers, perhaps because blue-collar workers have less control over their own work schedules and activities (Avolio & Sosik, 1999 ). When different aspects of jobs are considered, intrinsic satisfaction—happiness with the work itself—shows a strong age-related gain. Extrinsic satisfaction—contentment with supervision, pay, and promotions—changes very little (Barnes-Farrell & Matthews, 2007 ).

image25

FIGURE 16.6 Age-related changes in job satisfaction.

In this study of more than 2,000 university employees at all levels, from secretary to university president, job satisfaction dropped slightly in early adulthood as people encountered some discouraging experiences (see Chapter 14 ). In middle age, job satisfaction showed a steady rise.

(From W. A. Hochwarter et al., 2001, “A Note on the Nonlinearity of the Age–Job-Satisfaction Relationship,” Journal of Applied Social Psychology, 31, p. 1232. Copyright © 2001, John Wiley and Sons. Reproduced with permission of Wiley Inc.)

What explains the rise in job satisfaction during middle adulthood? An improved capacity to cope effectively with difficult situations and a broader time perspective probably contribute. “When I first started teaching, I complained about a lot of things,” remarked Devin. “From my current vantage point, I can tell a big problem from a trivial one.” Moving out of unrewarding work roles, as Trisha did, can also boost morale. Key characteristics that predict job well-being include involvement in decision making, reasonable workloads, and good physical working conditions. Older people may have greater access to jobs that are attractive in these ways. Furthermore, having fewer alternative positions into which they can move, older workers generally reduce their career aspirations (Barnes-Farrell & Matthews, 2007 ). As the perceived gap between actual and possible achievements narrows, job involvement—importance of one’s work to self-esteem—increases (Warr, 2001 ).

Although emotional engagement with work is usually seen as psychologically healthy, it can also result in burnout —a condition in which long-term job stress leads to mental exhaustion, a sense of loss of personal control, and feelings of reduced accomplishment. Burnout occurs more often in the helping professions, including health care, human services, and teaching, which place high emotional demands on employees. Although people in interpersonally demanding jobs are as psychologically healthy as other people, sometimes a worker’s dedication exceeds his or her coping skills, especially in an unsupportive work environment (Schmidt, Neubach, & Heuer, 2007 ). Burnout is associated with excessive work assignments for available time and lack of encouragement and feedback from supervisors. It tends to occur more often in the United States than in Western Europe, perhaps because of Americans’ greater achievement orientation (Maslach, Schaufeli, & Leiter, 2001 ).

Burnout is a serious occupational hazard, linked to impaired attention and memory, severe depression, on-the-job injuries, physical illnesses, poor job performance, absenteeism, and turnover (Sandström et al., 2005 ; Wang, 2005 ). To prevent burnout, employers can make sure workloads are reasonable, provide opportunities for workers to take time out from stressful situations, limit hours of stressful work, and offer social support. Interventions that enlist employees’ participation in designing higher-quality work environments show promise for increasing work engagement and effectiveness and reducing burnout (Leiter, Gascón, & Martínez-Jarreta, 2010 ). And provisions for working at home may respond to the needs of some people for a calmer, quieter work atmosphere.

Career Development

After several years as a parish nurse, Anya felt a need for additional training to do her job better. Trisha appreciated her firm’s generous support of workshop and course attendance, which helped her keep abreast of new legal developments. And as college dean, Devin took a summer seminar each year on management effectiveness. As these experiences reveal, career development is vital throughout work life.

Job Training.

Anya’s 35-year-old supervisor, Roy, was surprised when she asked for time off to upgrade her skills. “You’re in your fifties,” he replied. “What’re you going to do with so much new information at this point in your life?”

Roy’s insensitive, narrow-minded response, though usually unspoken, is all too common among managers—even some who are older themselves! Research suggests that training and on-the-job career counseling are less available to older workers. And when career development activities are offered, older employees may be less likely to volunteer for them (Barnes-Farrell & Matthews, 2007 ; Hedge, Borman, & Lammlein, 2006 ). What influences willingness to engage in job training and updating?

Personal characteristics are important: With age, growth needs give way somewhat to security needs. Consequently, learning and challenge may have less intrinsic value to many older workers. Perhaps for this reason, older employees depend more on co-worker and supervisor encouragement for vocational development. Yet as we have seen, they are less likely to have supportive supervisors. Furthermore, negative stereotypes of aging reduce older workers’ self-efficacy, or confidence that they can get better at their jobs (Maurer, 2001 ; Maurer, Wrenn, & Weiss, 2003 ). Self-efficacy is a powerful predictor of employees’ efforts to renew and expand career-relevant skills.

Workplace characteristics matter, too. An employee given work that requires new learning must pursue that learning to complete the assignment. Unfortunately, older workers sometimes receive more routine tasks than younger workers. Therefore, some of their reduced motivation to engage in career-relevant learning may be due to the type of assignments they receive. In companies with a more favorable age climate (view of older workers), mature employees participate frequently in further education and report greater self-efficacy and commitment to the organization (Bowen, Noack, & Staudinger, 2011 ).

Gender and Ethnicity: The Glass Ceiling.

In her thirties, Jewel became a company president by starting her own business. Having concluded that, as a woman, she had little chance of rising to a top executive position in a large corporation, she didn’t even try. Although women and ethnic minorities have gradually gained in access to managerial careers, they remain a long distance from gender and ethnic equality (Huffman, 2012 ). From career entry on, inequalities in promotion between men and women and between whites and blacks become more pronounced over time—findings still evident after education, work skills, and work productivity have been controlled (Barreto, Ryan, & Schmitt, 2009 ; Maume, 2004 ). Women who are promoted usually get stuck in mid-level positions. When the most prestigious high-level management jobs are considered, white men are overwhelmingly advantaged: They account for 70 percent of chief executive officers at large corporations and 93 percent at Fortune 500 companies (U.S. Census Bureau, 2012b ).

image26

Facebook executive Sheryl Sandberg is among a handful of women who have attained top positions in major corporations. In her best-selling book, Lean In, she urges women to be more assertive in demonstrating qualities linked to leadership at work.

Women and ethnic minorities face a glass ceiling, or invisible barrier to advancement up the corporate ladder. Why is this so? Management is an art and skill that must be taught. Yet women and ethnic minorities have less access to mentors, role models, and informal networks that serve as training routes (Baumgartner & Schneider, 2010 ). And stereotyped doubts about women’s career commitment and ability to become strong managers (especially women with children) also contribute, leading supervisors to underrate their competence and not to recommend them for formal management training programs (Hoobler, Lemmon, & Wayne, 2011 ). Furthermore, challenging, high-risk, high-visibility assignments that require leadership and open the door to advancement, such as startup ventures, international experience, and troubleshooting, are less often granted to both women and minorities.

Finally, women who demonstrate qualities linked to leadership and advancement—assertiveness, confidence, forcefulness, and ambition—encounter prejudice because they deviate from traditional gender roles, even though they more often combine these traits with a democratic, collaborative style of leading than do men (Cheung & Halpern, 2010 ; Eagly & Carli, 2007 ). To overcome this bias, women in line for top positions must demonstrate greater competence than their male counterparts. In an investigation of several hundred senior managers at a multinational financial services corporation, promoted female managers had earned higher performance ratings than promoted male managers (Lyness & Heilman, 2006 ). In contrast, no gender difference existed in performance of managers not selected for promotion.

Like Jewel, many women have dealt with the glass ceiling by going around it, leaving the corporate environment and going into business for themselves. Today, more than half of all startup businesses in the United States are owned and operated by women. The large majority are successful entrepreneurs and leaders, meeting or exceeding their expansion and earnings goals (Ahuja, 2005 ; U.S. Census Bureau, 2012b ). But when women and ethnic minorities leave the corporate world to further their careers, companies not only lose valuable talent but also fail to address the leadership needs of an increasingly diverse work force.

Career Change at Midlife

Although most people remain in the same vocation through middle age, career change does occur, as with Elena’s shift from journalism to teaching and creative writing. Recall that circumstances at home and at work motivated Elena’s decision to pursue a new vocation. Like other career changers, she wanted a more satisfying life—a goal she attained by ending an unhappy marriage and initiating a long-awaited vocational move at the same time.

As noted earlier, midlife career changes are seldom radical; they typically involve leaving one line of work for a related one. Elena sought a more stimulating, involving job. But other people move in the reverse direction—to careers that are more relaxing, free of painful decisions, and less demanding (Juntunen, Wegner, & Matthews, 2002 ). The decision to change is often difficult. The individual must weigh years invested in one set of skills, current income, and job security against present frustrations and hoped-for gains.

image27

Emotional and Social Development in Middle Adulthood homework help

After many years as a professor of ancient Greek philosophy, Abe Schoener found himself at a dead end in his career. In his mid-forties, he decided to transform his passion for winemaking into a new vocation as a vintner—a radical shift that prompted the breakup of his marriage but ultimately led to a more satisfying life.

An extreme career shift, by contrast, usually signals a personal crisis (Young & Rodgers, 1997 ). In a study of professionals who abandoned their well-paid, prestigious positions for routine, poorly paid, semiskilled work, nonwork problems contributed to radical change. An eminent 55-year-old TV producer became a school bus driver, a New York banker a waiter in a ski resort (Sarason, 1977 ). Each was responding to feelings of personal meaninglessness—escaping from family conflict, difficult relationships with colleagues, and work that had become unsatisfying to a less burdensome life.

Among blue-collar workers—those in such occupations as construction, manufacturing, mining, maintenance, or foodservice work—midlife career shifts are seldom freely chosen. In one investigation, researchers followed a large sample of blue-collar men in their fifties over a seven-year period; all were employed by Alcoa, the world’s largest producer of aluminum. One-third had highly physically taxing jobs. Of the small minority who transitioned to less physically demanding work, an injury usually preceded the change (Modrek & Cullen, 2012 ). Transitioners appeared to change jobs to stay in the workforce, rather than being forced to retire early, at less than full pension benefits, because of their disability.

Yet opportunities to shift to less physically demanding work are limited, particularly in the late-2000s recession aftermath. A strong predictor of middle-aged workers’ eligibility for such jobs for is education—at least a high school diploma (Blau & Goldstein, 2007 ). Less educated workers with a physical disability face greatly reduced chances of remaining in the labor force.

Unemployment

As companies downsize, eliminating jobs, the majority of people affected are middle-aged and older. Although unemployment is difficult at any time, middle-aged adults show a sharper decline in physical and mental health than their younger counterparts. Those who perceive a company’s layoff process as unfair and inconsiderate—for example, giving them little time to prepare—often experience the event as highly traumatic (Breslin & Mustard, 2003 ; McKee-Ryan et al., 2009 ). Older workers affected by layoffs remain jobless longer, suffering substantial income loss. In addition, people over age 40 who must reestablish occupational security find themselves “off-time” in terms of the social clock. Consequently, job loss can disrupt major tasks of midlife, including generativity and reappraisal of life goals and accomplishments. Finally, having been more involved in and committed to an occupation, the older unemployed worker has also lost something of greater value.

People who lose their jobs in midlife, whether executives or blue-collar workers, seldom duplicate the status and pay of their previous positions. As they search, they encounter age discrimination and find that they are over-qualified for many openings. Those also facing financial difficulties are at risk for deepening depression and physical health declines over time (Gallo et al., 2006 ; McKee-Ryan, 2011 ). Counseling that focuses on financial planning, reducing feelings of humiliation due to the stigma of unemployment, and encouraging personal flexibility can help people implement effective problem-centered coping strategies in their search for alternative work roles.

Planning for Retirement

One evening, Devin and Trisha met Anya and her husband, George, for dinner. Halfway through the meal, Devin inquired, “George, tell us what you and Anya are going to do about retirement. Are you planning to close down your business or work part-time? Do you think you’ll stay here or move out of town?”

Three or four generations ago, the two couples would not have had this conversation. In 1900, about 70 percent of American men age 65 and over were in the labor force. By 1970, however, the figure had dropped to 27 percent, and in the early twenty-first century it declined to 16 percent (U.S. Census Bureau, 2012b ). Because of government-sponsored retirement benefits (begun in the United States in 1935), retirement is no longer a privilege reserved for the wealthy. The federal government pays Social Security to the majority of the aged, and others are covered by employer-based private pension plans.

As the trend just noted suggests, the average age of retirement has declined over the past several decades. Currently, it is age 63 in the United States and hovers between 60 and 63 in other Western nations (U.S. Census Bureau, 2012b ). The recent recession led to an increase in the number of Americans at risk for being unable to sustain their preretirement standard of living after leaving the workforce. Consequently, a survey of a large, nationally representative sample of baby boomers revealed that the majority expect to delay retirement (Jones, 2012 ). But current estimates indicate that most will need to work just a few extra years to be financially ready to retire (Munnell et al., 2012 ). For the healthy, active, long-lived baby-boom generation, up to one-fourth of their lives may lie ahead after they leave their jobs.

Applying What We Know : Ingredients of Effective retirement Planning

Issue

Description

Finances

Ideally, financial planning for retirement should start with the first paycheck; at a minimum, it should begin 10 to 15 years before retirement.

Fitness

Starting a fitness program in middle age is important because good health is crucial for well-being in retirement.

Role adjustment

Retirement is harder for people who strongly identify with their work role. Preparing for a radical role adjustment reduces stress.

Where to live

The pros and cons of moving should be considered carefully because where one lives affects access to health care, friends, family, recreation, entertainment, and part-time employment.

Leisure and volunteer activities

A retiree typically gains an additional 50 hours per week of free time. Careful planning of what to do with that time has a major impact on psychological well-being.

Health insurance

Finding out about government-sponsored health insurance options helps protect quality of life after retirement.

Legal affairs

The preretirement period is an excellent time to finalize a will and begin estate planning.

Retirement is a lengthy, complex process that begins as soon as the middle-aged person first thinks about it (Kim & Moen, 2002b ). Planning is important because retirement leads to a loss of two important work-related rewards—income and status—and to a change in many other aspects of life. Like other life transitions, retirement can be stressful.

Nearly half of middle-aged people engage in no concrete retirement planning, yet research consistently shows that clarifying goals for the future and acquiring financial-planning knowledge result in better retirement savings, adjustment, and satisfaction (Hershey et al., 2007 ; Jacobs-Lawson, Hershey, & Neukam, 2004 ).

LOOK AND LISTEN

Contact the human resources division of a company or institution in your community, and inquire about the retirement planning services it offers. How comprehensive are those services, and what percentage of its recent retirees made use of them?•

Applying What We Know above lists the variety of issues addressed in a typical retirement preparation program. Financial planning is especially vital in the United States where (unlike Western European nations) the federal government does not offer a pension system that guarantees an adequate standard of living (see page 68 in Chapter 2 ). Hence, U.S. retirees’ income typically drops by 50 percent. But although more people engage in financial planning than in other forms of preparation, even those who attend financial education programs often fail to look closely at their financial well-being and to make wise decisions (Keller & Lusardi, 2012 ). Many could benefit from an expert’s financial analysis and counsel.

Retirement leads to ways of spending time that are largely guided by one’s interests rather than one’s obligations. Individuals who have not thought carefully about how to fill this time may find their sense of purpose in life seriously threatened. Research reveals that planning for an active life has an even greater impact on happiness after retirement than financial planning. Participation in activities promotes many factors essential for psychological well-being, including a structured time schedule, social contact, and self-esteem (Schlossberg, 2004 ). Carefully considering whether or not to relocate at retirement is related to an active life, since it affects access to health care, friends, family, recreation, entertainment, and part-time work.

Devin retired at age 62, George at age 66. Though several years younger, Trisha and Anya—like many married women—coordinated their retirements with those of their husbands. In contrast, Jewel—in good health but without an intimate partner to share her life—kept her consulting business going until age 75. Tim took early retirement and moved to be near Elena, where he devoted himself to public service—tutoring second graders in a public school, transporting inner-city children to museums, and coaching after-school and weekend youth sports. For Tim, retirement offered a new opportunity to give generously to his community.

Unfortunately, less well-educated people with lower lifetime earnings are least likely to attend retirement preparation programs—yet they stand to benefit the most. And compared with men, women do less planning for retirement, instead relying on their husband’s preparations. This gender gap seems to be narrowing, however, as women increasingly contribute to family income (Adams & Rau, 2011 ). Employers must take extra steps to encourage lower-paid workers and women to participate in planning activities. In addition, enhancing retirement adjustment among the economically disadvantaged depends on access to better vocational training, jobs, and health care at early ages. Clearly, a lifetime of opportunities and experiences affects the transition to retirement. In Chapter 18 , we will consider the decision to retire and retirement adjustment in greater detail.

ASK YOURSELF

REVIEW What factors contribute to the rise in job satisfaction with age?

CONNECT Supervisors sometimes assign the more routine tasks to older workers, believing that they can no longer handle complex assignments. Cite evidence from this and the previous chapter indicating that this assumption is incorrect.

APPLY An executive wonders how his large corporation can foster advancement of women and ethnic minorities to upper management positions. What strategies would you recommend?

image28 SUMMARY

Erikson’s Theory: Generativity versus Stagnation ( p. 532 )

According to Erikson, how does personality change in middle age?

· ● Generativity expands as middle-aged adults face Erikson’s psychological conflict of generativity versus stagnation. Personal desires and cultural demands jointly shape adults’ generative activities.

· ● Highly generative people, who contribute to society through parenthood, other family relationships, the workplace, and volunteer endeavors, appear especially well-adjusted. Stagnation occurs when people become self-centered and self-indulgent in midlife.

Other Theories of Psychosocial Development in Midlife ( p. 535 )

· Describe Levinson’s and Vaillant’s views of psychosocial development in middle adulthood, and discuss similarities and differences between men and women.

· ● According to Levinson, middle-aged adults confront four developmental tasks, each requiring them to reconcile two opposing tendencies within the self: young–old, destruction–creation, masculinity–femininity, and engagement–separateness.

· ● Middle-aged men show greater acceptance of “feminine” traits of nurturance and caring, while women are more open to “masculine” characteristics of autonomy and assertiveness. Men and successful career-oriented women may reduce their concern with ambition and achievement, but women who have devoted themselves to child rearing or an unfulfilling job often seek rewarding work or community engagement.

· ● Vaillant found that adults in their late forties and fifties become guardians of their culture, seeking to “pass the torch” to later generations.

Does the term midlife crisis reflect most people’s experience of middle adulthood, and is middle adulthood accurately characterized as a stage?

· ● Most people respond to midlife with changes that are better described as “turning points” than as a crisis. Only a minority experience a midlife crisis characterized by intense self-doubt and stress that lead to drastic life alterations.

· ● Some midlife changes are adaptations to life events that are less age-graded than in the past. Most middle-aged adults also report troubling moments that prompt new understandings and goals, but debate persists over whether these psychosocial changes are stagelike.

Stability and Change in Self-Concept and Personality ( p. 538 )

· Describe changes in self-concept, personality, and gender identity in middle adulthood.

· ● Middle-aged individuals maintain self-esteem and stay motivated by revising their possible selves, which become fewer in number as well as more modest and concrete as people adjust their hopes and fears to their life circumstances.

· ● Midlife typically brings enhanced psychological well-being, through greater self-acceptance, autonomy, and environmental mastery. Factors contributing to well-being, however, vary widely among cohorts and cultures.

· ● Daily stressors plateau in early to mid-adulthood, and then decline as work and family responsibilities ease. Midlife gains in emotional stability and confidence in handling life’s problems lead to increased effectiveness in coping with stressors.

· ● Both men and women become more androgynous in middle adulthood. Biological explanations, such as parental imperative theory, are controversial. A combination of social roles and life conditions is more likely responsible. image29

· Discuss stability and change in the “big five” personality traits in adulthood.

· ● Among the “big five” personality traits, agreeableness and conscientiousness increase into middle age, while neuroticism declines, and extroversion and openness to experience do not change or decrease slightly. Individual differences are large and highly stable: Although adults change in overall organization and integration of personality, they do so on a foundation of basic, enduring dispositions.

Relationships at Midlife ( p. 543 )

· Describe the middle adulthood phase of the family life cycle.

· ● “Launching children and moving on” is the midlife phase of the family life cycle. Adults must adapt to many entries and exits of family members as their children launch–return–relaunch, marry, and produce grandchildren, and as their own parents age and die.

· ● When divorce occurs, middle-aged adults seem to adapt more easily than younger people. For women, midlife marital breakup often severely reduces standard of living, contributing to the feminization of poverty.

· ● Most middle-aged parents adjust well to launching adult children, especially if positive parent–child relationships are sustained, but adult children who are “off-time” in development can prompt parental strain. As children marry, middle-aged parents, especially mothers, often become kinkeepers.

· ● Grandparents’ contact and closeness with grandchildren depend on proximity, number of grandchild sets, sex of grandparent and grandchild, and in-law relationships. In low-income families and in some ethnic groups, grandparents provide essential financial and child-care assistance. When serious family problems exist, grandparents may become primary caregivers in skipped-generation families. image30

· ● Middle-aged adults reassess their relationships with aging parents, often becoming more appreciative. Mother–daughter relationships tend to be closer than other parent–child ties. The more positive the history of the parent–child tie and the greater the need for assistance, the more help exchanged.

· ● Middle-aged adults, often caught between caring for aging parents, assisting young-adult children and grandchildren, and meeting work and community responsibilities, are called the sandwich generation. The burden of caring for ill or frail parents falls most heavily on adult daughters, though the sex difference declines in later middle age.

· ● Parental caregiving has emotional and health consequences, especially in cultures and subcultures where adult children feel a particularly strong obligation to provide care. Social support is highly effective in reducing caregiver stress and helping adult children derive benefits from caregiving.

Describe midlife sibling relationships and friendships.

· ● Sibling contact and support decline from early to middle adulthood, probably because of the demands of diverse roles. But many middle-aged siblings feel closer, often in response to major life events. Sister–sister ties are typically closest in industrialized nations. In nonindustrialized societies, strong brother–sister attachments may be basic to family functioning.

· ● In midlife, friendships become fewer, more selective, and more deeply valued. Men continue to be less expressive with their friends than women, who have more close friendships. Viewing a spouse as a best friend can contribute greatly to marital happiness.

Vocational Life ( p. 553 )

· Discuss job satisfaction and career development in middle adulthood, with special attention to sex differences and experiences of ethnic minorities.

· ● Vocational readjustments are common as middle-aged people seek to increase the personal meaning and self-direction of their work lives. Certain aspects of job performance improve. Job satisfaction increases at all occupational levels, more so for men than for women.

· ● Burnout is a serious occupational hazard, especially for those in helping professions. It can be prevented by ensuring reasonable workloads, limiting hours of stressful work, providing workers with social support, and enlisting employees’ participation in designing higher-quality work environments.

· ● Both personal and workplace characteristics influence the extent to which older workers engage in career development. In companies with a more favorable age climate, mature employees report greater self-efficacy and commitment to the organization.

· ● Women and ethnic minorities face a glass ceiling because of limited access to management training and prejudice against women who demonstrate strong leadership qualities. Many women further their careers by leaving the corporate world, often to start their own businesses.

Discuss career change and unemployment in middle adulthood.

· ● Midlife career change typically involves leaving one line of work for a related one. Radical career change often signals a personal crisis. Among blue-collar workers, midlife career shifts are seldom freely chosen. image31

· ● Unemployment is especially difficult for middle-aged adults, who constitute the majority of workers affected by corporate downsizing and layoffs. Counseling can help them find alternative, gratifying work roles, but these rarely match their previous status and pay.

Discuss the importance of planning for retirement.

· ● Retirement brings major life changes, including loss of income and status and an increase in free time. Besides financial planning, planning for an active life is vital, with a strong impact on happiness after retirement. Low-paid workers and women need extra encouragement to participate in retirement planning.

Important Terms and Concepts

“big five” personality traits ( p. 542 )

burnout ( p. 554 )

feminization of poverty ( p. 544 )

generativity versus stagnation ( p. 532 )

glass ceiling ( p. 555 )

kinkeeper ( p. 545 )

midlife crisis ( p. 536 )

parental imperative theory ( p. 540 )

possible selves ( p. 538 )

sandwich generation ( p. 549 )

skipped-generation family ( p. 548 )

image32 milestones Development in Middle Adulthood

image33

40–50 years

· PHYSICAL

· ■ Accommodative ability of the lens of the eye, ability to see in dim light, and color discrimination decline; sensitivity to glare increases. ( 502 – 503 )

· ■ Hearing loss at high frequencies occurs. ( 503 )

· ■ Hair grays and thins. ( 502 )

· ■ Lines on the face become more pronounced; skin loses elasticity and begins to sag. ( 503 )

· ■ Weight gain continues, accompanied by a rise in fatty deposits in the torso, while fat beneath the skin declines. ( 504 )

· ■ Loss of lean body mass (muscle and bone) occurs. ( 504 )

· ■ In women, production of estrogen drops, leading to shortening and irregularity of the menstrual cycle. ( 504 ) image34

· ■ In men, quantity of semen and sperm declines. ( 507 )

· ■ Intensity of sexual response declines, but frequency of sexual activity drops only slightly. ( 509 )

· ■ Rates of cancer and cardiovascular disease increase. ( 509 – 513 )

COGNITIVE

· ■ Consciousness of aging increases. (502, 535)

· ■ Crystallized intelligence increases; fluid intelligence declines. ( 518 – 519 )

· ■ Speed of processing declines, but adults can compensate through experience and practice. ( 520 – 521 ) image35

· ■ Ability to attend selectively and to adapt attention—switching from one task to another—declines, but adults can compensate through experience and practice. ( 521 )

· ■ Amount of information retained in working memory declines, in part because of reduced use of memory strategies. ( 522 )

· ■ Retrieving information from long-term memory becomes more difficult. ( 522 )

· ■ General factual knowledge, procedural knowledge, knowledge related to one’s occupation, and metacognitive knowledge remain unchanged or may increase. ( 522 – 523 ) image36

· ■ Practical problem solving and expertise increase. ( 524 )

· ■ Creativity may become more deliberately thoughtful, emphasize integrating ideas, and shift from self-expression to more altruistic goals. ( 524 – 525 ) image37

· ■ If occupation offers challenge and autonomy, may show gains in cognitive flexibility. ( 525 – 526 )

EMOTIONAL/SOCIAL

· ■ Generativity increases. ( 532 – 533 )

· ■ Focus shifts toward personally meaningful living. ( 535 ) image38

· ■ Possible selves become fewer in number and more modest and concrete. ( 538 )

· ■ Self-acceptance, autonomy, and environmental mastery increase. ( 538 – 539 )

· ■ Strategies for coping with stressors become more effective. ( 539 )

· ■ Gender identity becomes more androgynous;

“masculine” traits increase in women, “feminine” traits in men. (535, 540–542)

· ■ Agreeableness and conscientiousness increase, while neuroticism declines. ( 542 )

· ■ May launch children. ( 544 – 545 )

· ■ May become a kinkeeper, especially if a mother. ( 545 )

· ■ May become a parent-in-law and a grandparent. ( 545 – 547 )

· ■ Becomes more appreciative of parents’ strengths and generosity; quality of relationships with parents increase. ( 547 )

· ■ May care for a parent with a disability or chronic illness. ( 549 – 551 )

· ■ Siblings may feel closer. ( 552 ) image39

· ■ Number of friends generally declines. ( 552 )

· ■ Intrinsic job satisfaction—happiness with one’s work—typically increases. ( 553 – 554 ) image40

50–65 years

PHYSICAL

· ■ Lens of the eye loses its capacity to adjust to objects at varying distances entirely. ( 502 )

· ■ Hearing loss gradually extends to all frequencies but remains greatest for high frequencies. ( 503 )

· ■ Skin continues to wrinkle and sag, “age spots” increase, and blood vessels in the skin become more visible. ( 503 )

· ■ In women, menopause occurs; as estrogen declines further, genitals are less easily stimulated, and the vagina lubricates more slowly during arousal. ( 504 )

· ■ In men, inability to attain an erection when desired becomes more common. ( 507 )

· ■ Loss of bone mass continues; rates of osteoporosis rise. (504, 512–513)

· ■ Collapse of disks in the spinal column causes height to drop by as much as 1 inch. ( 504 )

· ■ Rates of cancer and cardiovascular disease continue to increase. ( 509 – 513 ) image41

COGNITIVE

· ■ Cognitive changes previously listed continue. image42

EMOTIONAL/SOCIAL

· ■ Emotional and social changes previously listed continue. image43

· ■ Parent-to-child help-giving declines, and child-to-parent support and practical assistance increase. ( 548 – 549 ) image44

· ■ May retire. ( 556 – 557 )

Note: Numbers in parentheses indicate the page or pages on which each milestone is discussed.

 
Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

Physical Development in Infancy and Toddlerhood homework help

Physical Development in Infancy and Toddlerhood homework help

chapter 4 Physical Development in Infancy and Toddlerhood

Infants acquire new motor skills by building on previously acquired capacities. Eager to explore her world, this baby practices the art of crawling. Once she can fully move on her own, she will make dramatic strides in understanding her surroundings.

chapter outline

·   Body Growth

·   Changes in Body Size and Muscle–Fat Makeup

·   Individual and Group Differences

·   Changes in Body Proportions

·   Brain Development

·   Development of Neurons

·   Neurobiological Methods

·   Development of the Cerebral Cortex

·   Sensitive Periods in Brain Development

·   Changing States of Arousal

· ■  BIOLOGY AND ENVIRONMENT  Brain Plasticity: Insights from Research on Brain-Damaged Children and Adults

· ■  CULTURAL INFLUENCES  Cultural Variation in Infant Sleeping Arrangements

·   Influences on Early Physical Growth

·   Heredity

·   Nutrition

·   Malnutrition

·   Learning Capacities

·   Classical Conditioning

·   Operant Conditioning

·   Habituation

·   Imitation

·   Motor Development

·   The Sequence of Motor Development

·   Motor Skills as Dynamic Systems

·   Fine-Motor Development: Reaching and Grasping

·   Perceptual Development

·   Hearing

·   Vision

·   Intermodal Perception

·   Understanding Perceptual Development

· ■  BIOLOGY AND ENVIRONMENT “Tuning In” to Familiar Speech, Faces, and Music: A Sensitive Period for Culture-Specific Learning

On a brilliant June morning, 16-month-old Caitlin emerged from her front door, ready for the short drive to the child-care home where she spent her weekdays while her mother, Carolyn, and her father, David, worked. Clutching a teddy bear in one hand and her mother’s arm with the other, Caitlin descended the steps. “One! Two! Threeee!” Carolyn counted as she helped Caitlin down. “How much she’s changed,” Carolyn thought to herself, looking at the child who, not long ago, had been a newborn. With her first steps, Caitlin had passed from infancy to toddlerhood—a period spanning the second year of life. At first, Caitlin did, indeed, “toddle” with an awkward gait, tipping over frequently. But her face reflected the thrill of conquering a new skill.

As they walked toward the car, Carolyn and Caitlin spotted 3-year-old Eli and his father, Kevin, in the neighboring yard. Eli dashed toward them, waving a bright yellow envelope. Carolyn bent down to open the envelope and took out a card. It read, “Announcing the arrival of Grace Ann. Born: Cambodia. Age: 16 months.” Carolyn turned to Kevin and Eli. “That’s wonderful news! When can we see her?”

“Let’s wait a few days,” Kevin suggested. “Monica’s taken Grace to the doctor this morning. She’s underweight and malnourished.” Kevin described Monica’s first night with Grace in a hotel room in Phnom Penh. Grace lay on the bed, withdrawn and fearful. Eventually she fell asleep, gripping crackers in both hands.

Carolyn felt Caitlin’s impatient tug at her sleeve. Off they drove to child care, where Vanessa had just dropped off her 18-month-old son, Timmy. Within moments, Caitlin and Timmy were in the sandbox, shoveling sand into plastic cups and buckets with the help of their caregiver, Ginette.

A few weeks later, Grace joined Caitlin and Timmy at Ginette’s child-care home. Although still tiny and unable to crawl or walk, she had grown taller and heavier, and her sad, vacant gaze had given way to an alert expression, a ready smile, and an enthusiastic desire to imitate and explore. When Caitlin headed for the sandbox, Grace stretched out her arms, asking Ginette to carry her there, too. Soon Grace was pulling herself up at every opportunity. Finally, at age 18 months, she walked!

This chapter traces physical growth during the first two years—one of the most remarkable and busiest times of development. We will see how rapid changes in the infant’s body and brain support learning, motor skills, and perceptual capacities. Caitlin, Grace, and Timmy will join us along the way to illustrate individual differences and environmental influences on physical development.

image1 Body Growth

TAKE A MOMENT…  The next time you’re walking in your neighborhood park or at the mall, note the contrast between infants’ and toddlers’ physical capabilities. One reason for the vast changes in what children can do over the first two years is that their bodies change enormously—faster than at any other time after birth.

Changes in Body Size and Muscle–Fat Makeup

By the end of the first year, a typical infant’s height is about 32 inches—more than 50 percent greater than at birth. By 2 years, it is 75 percent greater (36 inches). Similarly, by 5 months of age, birth weight has doubled, to about 15 pounds. At 1 year it has tripled, to 22 pounds, and at 2 years it has quadrupled, to about 30 pounds.

FIGURE 4.1 Body growth during the first two years.

These photos depict the dramatic changes in body size and proportions during infancy and toddlerhood in two individuals—a boy, Chris, and a girl, Mai. In the first year, the head is quite large in proportion to the rest of the body, and height and weight gain are especially rapid. During the second year, the lower portion of the body catches up. Notice, also, how both children added “baby fat” in the early months of life and then slimmed down, a trend that continues into middle childhood.

Figure 4.1  illustrates this dramatic increase in body size. But rather than making steady gains, infants and toddlers grow in little spurts. In one study, children who were followed over the first 21 months of life went for periods of 7 to 63 days with no growth, then added as much as half an inch in a 24-hour period! Almost always, parents described their babies as irritable and very hungry on the day before the spurt (Lampl,  1993 ; Lampl, Veldhuis, & Johnson,  1992 ).

One of the most obvious changes in infants’ appearance is their transformation into round, plump babies by the middle of the first year. This early rise in “baby fat,” which peaks at about 9 months, helps the small infant maintain a constant body temperature. In the second year, most toddlers slim down, a trend that continues into middle childhood (Fomon & Nelson,  2002 ). In contrast, muscle tissue increases very slowly during infancy and will not reach a peak until adolescence. Babies are not very muscular; their strength and physical coordination are limited.

Individual and Group Differences

In infancy, girls are slightly shorter and lighter than boys, with a higher ratio of fat to muscle. These small sex differences persist throughout early and middle childhood and are greatly magnified at adolescence. Ethnic differences in body size are apparent as well. Grace was below the growth norms (height and weight averages for children her age). Early malnutrition contributed, but even after substantial catch-up, Grace—as is typical for Asian children—remained below North American norms. In contrast, Timmy is slightly above average, as African-American children tend to be (Bogin,  2001 ).

Children of the same age also differ in rate of physical growth; some make faster progress toward a mature body size than others. But current body size is not enough to tell us how quickly a child’s physical growth is moving along. Although Timmy is larger and heavier than Caitlin and Grace, he is not physically more mature. In a moment, you will see why.

The best estimate of a child’s physical maturity is skeletal age, a measure of bone development. It is determined by X-raying the long bones of the body to see the extent to which soft, pliable cartilage has hardened into bone, a gradual process that is completed in adolescence. When skeletal ages are examined, African-American children tend to be slightly ahead of Caucasian children at all ages, and girls are considerably ahead of boys. At birth, the sexes differ by about 4 to 6 weeks, a gap that widens over infancy and childhood (Tanner, Healy, & Cameron,  2001 ). This greater physical maturity may contribute to girls’ greater resistance to harmful environmental influences. As noted in  Chapter 2 , girls experience fewer developmental problems than boys and have lower infant and childhood mortality rates.

Changes in Body Proportions

As the child’s overall size increases, different parts of the body grow at different rates. Two growth patterns describe these changes. The first is the  cephalocaudal trend —from the Latin for “head to tail.” During the prenatal period, the head develops more rapidly than the lower part of the body. At birth, the head takes up one-fourth of total body length, the legs only one-third. Notice how, in  Figure 4.1 , the lower portion of the body catches up. By age 2, the head accounts for only one-fifth and the legs for nearly one-half of total body length.

In the second pattern, the  proximodistal trend , growth proceeds, literally, from “near to far”—from the center of the body outward. In the prenatal period, the head, chest, and trunk grow first, then the arms and legs, and finally the hands and feet. During infancy and childhood, the arms and legs continue to grow somewhat ahead of the hands and feet.

image2 Brain Development

At birth, the brain is nearer to its adult size than any other physical structure, and it continues to develop at an astounding pace throughout infancy and toddlerhood. We can best understand brain growth by looking at it from two vantage points: (1) the microscopic level of individual brain cells and (2) the larger level of the cerebral cortex, the most complex brain structure and the one responsible for the highly developed intelligence of our species.

Development of Neurons

The human brain has 100 to 200 billion  neurons , or nerve cells that store and transmit information, many of which have thousands of direct connections with other neurons. Unlike other body cells, neurons are not tightly packed together. Between them are tiny gaps, or  synapses , where fibers from different neurons come close together but do not touch (see  Figure 4.2 ). Neurons send messages to one another by releasing chemicals called  neurotransmitters , which cross the synapse.

FIGURE 4.2 Neurons and their connective fibers.

This photograph of several neurons, taken with the aid of a powerful microscope, shows the elaborate synaptic connections that form with neighboring cells.

FIGURE 4.3 Major milestones of brain development.

Formation of synapses is rapid during the first two years, especially in the auditory, visual, and language areas of the cerebral cortex. The prefrontal cortex undergoes more extended synaptic growth. In each area, overproduction of synapses is followed by synaptic pruning. The prefrontal cortex is among the last regions to attain adult levels of synaptic connections—in mid-to late adolescence. Myelination occurs at a dramatic pace during the first two years, more slowly through childhood, followed by an acceleration at adolescence and then a reduced pace in early adulthood. The multiple yellow lines indicate that the timing of myelination varies among different brain areas. For example, neural fibers myelinate over a longer period in the language areas, and especially in the prefrontal cortex, than in the visual and auditory areas.

(Adapted from Thompson & Nelson, 2001.)

The basic story of brain growth concerns how neurons develop and form this elaborate communication system.  Figure 4.3  summarizes major milestones of brain development. In the prenatal period, neurons are produced in the embryo’s primitive neural tube. From there, they migrate to form the major parts of the brain (see  Chapter 3 ,  page 82 ). Once neurons are in place, they differentiate, establishing their unique functions by extending their fibers to form synaptic connections with neighboring cells. During the first two years, neural fibers and synapses increase at an astounding pace (Huttenlocher,  2002 ; Moore, Persaud, & Torchia,  2013 ). A surprising aspect of brain growth is  programmed cell death , which makes space for these connective structures: As synapses form, many surrounding neurons die—20 to 80 percent, depending on the brain region (de Haan & Johnson,  2003 ; Stiles,  2008 ). Fortunately, during the prenatal period, the neural tube produces far more neurons than the brain will ever need.

As neurons form connections, stimulation becomes vital to their survival. Neurons that are stimulated by input from the surrounding environment continue to establish synapses, forming increasingly elaborate systems of communication that support more complex abilities. At first, stimulation results in a massive overabundance of synapses, many of which serve identical functions, thereby ensuring that the child will acquire the motor, cognitive, and social skills that our species needs to survive. Neurons that are seldom stimulated soon lose their synapses, in a process called  synaptic pruning  that returns neurons not needed at the moment to an uncommitted state so they can support future development. In all, about 40 percent of synapses are pruned during childhood and adolescence to reach the adult level (Webb, Monk, & Nelson,  2001 ). For this process to advance, appropriate stimulation of the child’s brain is vital during periods in which the formation of synapses is at its peak (Bryk & Fisher,  2012 ).

If few new neurons are produced after the prenatal period, what causes the dramatic increase in brain size during the first two years? About half the brain’s volume is made up of  glial cells , which are responsible for  myelination , the coating of neural fibers with an insulating fatty sheath (called myelin) that improves the efficiency of message transfer. Glial cells multiply rapidly from the fourth month of pregnancy through the second year of life—a process that continues at a slower pace through middle childhood and accelerates again in adolescence. Gains in neural fibers and myelination are responsible for the extraordinary gain in overall size of the brain—from nearly 30 percent of its adult weight at birth to 70 percent by age 2 (Johnson,  2011 ; Knickmeyer et al.,  2008 ).

Brain development can be compared to molding a “living sculpture.” First, neurons and synapses are overproduced. Then, cell death and synaptic pruning sculpt away excess building material to form the mature brain—a process jointly influenced by genetically programmed events and the child’s experiences. The resulting “sculpture” is a set of interconnected regions, each with specific functions—much like countries on a globe that communicate with one another (Johnston et al.,  2001 ). This “geography” of the brain permits researchers to study its developing organization and the activity of its regions using neurobiological methods.

Neurobiological Methods

Table 4.1  describes major measures of brain functioning. The first two methods detect changes in electrical activity in the cerebral cortex. In an electroencephalogram (EEG), researchers examine brain-wave patterns for stability and organization—signs of mature functioning of the cortex. And as the person processes a particular stimulus, event-related potentials (ERPs) detect the general location of brain-wave activity—a technique often used to study preverbal infants’ responsiveness to various stimuli, the impact of experience on specialization of specific brain regions, and atypical brain functioning in individuals with learning and emotional problems (DeBoer, Scott, & Nelson,  2007 ; deRegnier,  2005 ).

Neuroimaging techniques, which yield detailed, three-dimensional computerized pictures of the entire brain and its active areas, provide the most precise information about which brain regions are specialized for certain capacities and about abnormalities in brain functioning. The most promising of these methods is functional magnetic resonance imaging (fMRI). Unlike positron emission tomography (PET), fMRI does not depend on X-ray photography, which requires injection of a radioactive substance. Rather, when an individual is exposed to a stimulus, fMRI detects changes in blood flow and oxygen metabolism throughout the brain magnetically, yielding a colorful, moving picture of parts of the brain used to perform a given activity (see  Figure 4.4a ,  b , and  c ).

TABLE 4.1 Methods for Measuring Brain Functioning

METHOD DESCRIPTION
Electroencephalogram (EEG) Electrodes embedded in a head cap record electrical brain-wave activity in the brain’s outer layers—the cerebral cortex. Today, researchers use an advanced tool called a geodesic sensor net (GSN) to hold interconnected electrodes (up to 128 for infants and 256 for children and adults) in place through a cap that adjusts to each person’s head shape, yielding improved brain-wave detection.
Event-related potentials (ERPs) Using the EEG, the frequency and amplitude of brain waves in response to particular stimuli (such as a picture, music, or speech) are recorded in multiple areas of the cerebral cortex. Enables identification of general regions of stimulus-induced activity.
Functional magnetic resonance imaging (fMRI) While the person lies inside a tunnel-shaped apparatus that creates a magnetic field, a scanner magnetically detects increased blood flow and oxygen metabolism in areas of the brain as the individual processes particular stimuli. The scanner typically records images every 1 to 4 seconds; these are combined into a computerized moving picture of activity anywhere in the brain (not just its outer layers). Not appropriate for children younger than age 5 to 6, who cannot remain still during testing.
Positron emission tomography (PET) After injection or inhalation of a radioactive substance, the person lies on an apparatus with a scanner that emits fine streams of X-rays, which detect increased blood flow and oxygen metabolism in areas of the brain as the person processes particular stimuli. As with fMRI, the result is a computerized image of “online” activity anywhere in the brain. Not appropriate for children younger than age 5 to 6.
Near-infrared spectroscopy (NIRS) Using thin, flexible optical fibers attached to the scalp through a head cap, infrared (invisible) light is beamed at the brain; its absorption by areas of the cerebral cortex varies with changes in blood flow and oxygen metabolism as the individual processes particular stimuli. The result is a computerized moving picture of active areas in the cerebral cortex. Unlike fMRI and PET, NIRS is appropriate for infants and young children, who can move within limited range.

FIGURE 4.4 Functional magnetic resonance imaging (fMRI) and near-infrared spectroscopy (NIRS).

(a) This 6-year-old is part of a study that uses fMRI to find out how his brain processes light and motion. (b) The fMRI image shows which areas of the child’s brain are active while he views changing visual stimuli. (c) Here, NIRS is used to investigate a 2-month-old’s response to a visual stimulus. During testing, the baby can move freely within a limited range.

(Photo (c) from G. Taga, K. Asakawa, A. Maki, Y. Konishi, & H. Koisumi, 2003, “Brain Imaging in Awake Infants by Near-Infrared Optical Topography,” Proceedings of the National Academy of Sciences, 100, p. 10723. Reprinted by permission.)

Because PET and fMRI require that the participant lie as motionless as possible for an extended time, they are not suitable for infants and young children (Nelson, Thomas, & de Haan,  2006 ). A neuroimaging technique that works well in infancy and early childhood is near-infrared spectroscopy (NIRS), in which infrared (invisible) light is beamed at regions of the cerebral cortex to measure blood flow and oxygen metabolism while the child attends to a stimulus (refer again to  Table 4.1 ). Because the apparatus consists only of thin, flexible optical fibers attached to the scalp using a head cap, a baby can sit on the parent’s lap and move during testing—as  Figure 4.4c  illustrates (Hespos et al.,  2010 ). But unlike PET and fMRI, which map activity changes throughout the brain, NIRS examines only the functioning of the cerebral cortex.

Development of the Cerebral Cortex

The  cerebral cortex  surrounds the rest of the brain, resembling half of a shelled walnut. It is the largest brain structure, accounting for 85 percent of the brain’s weight and containing the greatest number of neurons and synapses. Because the cerebral cortex is the last part of the brain to stop growing, it is sensitive to environmental influences for a much longer period than any other part of the brain.

Regions of the Cerebral Cortex.

Figure 4.5  shows specific functions of regions of the cerebral cortex, such as receiving information from the senses, instructing the body to move, and thinking. The order in which cortical regions develop corresponds to the order in which various capacities emerge in the infant and growing child. For example, a burst of activity occurs in the auditory and visual cortexes and in areas responsible for body movement over the first year—a period of dramatic gains in auditory and visual perception and mastery of motor skills (Johnson,  2011 ). Language areas are especially active from late infancy through the preschool years, when language development flourishes (Pujol et al.,  2006 ; Thompson,  2000 ).

The cortical regions with the most extended period of development are the frontal lobes. The  prefrontal cortex , lying in front of areas controlling body movement, is responsible for thought—in particular, consciousness, inhibition of impulses, integration of information, and use of memory, reasoning, planning, and problem-solving strategies. From age 2 months on, the prefrontal cortex functions more effectively. But it undergoes especially rapid myelination and formation and pruning of synapses during the preschool and school years, followed by another period of accelerated growth in adolescence, when it reaches an adult level of synaptic connections (Nelson,  2002 ; Nelson, Thomas, & de Haan,  2006 ; Sowell et al.,  2002 ).

FIGURE 4.5 The left side of the human brain, showing the cerebral cortex.

The cortex is divided into different lobes, each containing a variety of regions with specific functions. Some major regions are labeled here.

Lateralization and Plasticity of the Cortex.

The cerebral cortex has two hemispheres, or sides, that differ in their functions. Some tasks are done mostly by the left hemisphere, others by the right. For example, each hemisphere receives sensory information from the side of the body opposite to it and controls only that side. *  For most of us, the left hemisphere is largely responsible for verbal abilities (such as spoken and written language) and positive emotion (such as joy). The right hemisphere handles spatial abilities (judging distances, reading maps, and recognizing geometric shapes) and negative emotion (such as distress) (Banish & Heller,  1998 ; Nelson & Bosquet,  2000 ). In left-handed people, this pattern may be reversed or, more commonly, the cerebral cortex may be less clearly specialized than in right-handers.

Why does this specialization of the two hemispheres, called  lateralization , occur? Studies using fMRI reveal that the left hemisphere is better at processing information in a sequential, analytic (piece-by-piece) way, a good approach for dealing with communicative information—both verbal (language) and emotional (a joyful smile). In contrast, the right hemisphere is specialized for processing information in a holistic, integrative manner, ideal for making sense of spatial information and regulating negative emotion. A lateralized brain may have evolved because it enabled humans to cope more successfully with changing environmental demands (Falk,  2005 ). It permits a wider array of functions to be carried out effectively than if both sides processed information exactly the same way.

*The eyes are an exception. Messages from the right half of each retina go to the right hemisphere; messages from the left half of each retina go to the left hemisphere. Thus, visual information from botheyes is received by both hemispheres.

Researchers study the timing of brain lateralization to learn more about brain plasticity. A highly plastic cerebral cortex, in which many areas are not yet committed to specific functions, has a high capacity for learning. And if a part of the cortex is damaged, other parts can take over tasks it would have handled.But once the hemispheres lateralize, damage to a specific region means that the abilities it controls cannot be recovered to the same extent or as easily as earlier.

At birth, the hemispheres have already begun to specialize. Most newborns show greater activation (detected with either ERP or NIRS) in the left hemisphere while listening to speech sounds or displaying a positive state of arousal. In contrast, the right hemisphere reacts more strongly to nonspeech sounds and to stimuli (such as a sour-tasting fluid) that evoke negative emotion (Davidson,  1994 ; Fox & Davidson,  1986 ; Hespos et al.,  2010 ).

Nevertheless, research on brain-damaged children and adults offers dramatic evidence for substantial plasticity in the young brain, summarized in the  Biology and Environment  box on  page 126 . Furthermore, early experience greatly influences the organization of the cerebral cortex. For example, deaf adults who, as infants and children, learned sign language (a spatial skill) depend more than hearing individuals on the right hemisphere for language processing (Neville & Bavelier,  2002 ). And toddlers who are advanced in language development show greater left-hemispheric specialization for language than their more slowly developing agemates (Luna et al.,  2001 ; Mills et al.,  2005 ). Apparently, the very process of acquiring language and other skills promotes lateralization.

In sum, the brain is more plastic during the first few years than it will ever be again. An overabundance of synaptic connections supports brain plasticity, ensuring that young children will acquire certain capacities even if some areas are damaged. And although the cortex is programmed from the start for hemispheric specialization, experience greatly influences the rate and success of its advancing organization.

Sensitive Periods in Brain Development

Both animal and human studies reveal that early, extreme sensory deprivation results in permanent brain damage and loss of functions—findings that verify the existence of sensitive periods in brain development. For example, early, varied visual experiences must occur for the brain’s visual centers to develop normally. If a 1-month-old kitten is deprived of light for just three or four days, these areas of the brain degenerate. If the kitten is kept in the dark during the fourth week of life and beyond, the damage is severe and permanent (Crair, Gillespie, & Stryker,  1998 ). And the general quality of the early environment affects overall brain growth. When animals reared from birth in physically and socially stimulating surroundings are compared with those reared under depleted conditions, the brains of the stimulated animals are larger and heavier and show much denser synaptic connections (Sale, Berardi, & Maffei,  2009 ).

Human Evidence: Victims of Deprived Early Environments.

For ethical reasons, we cannot deliberately deprive some infants of normal rearing experiences and observe the impact on their brains and competencies. Instead, we must turn to natural experiments, in which children were victims of deprived early environments that were later rectified. Such studies have revealed some parallels with the animal evidence just described.

For example, when babies are born with cataracts (clouded lenses, preventing clear visual images) in both eyes, those who have corrective surgery within four to six months show rapid improvement in vision, except for subtle aspects of face perception, which require early visual input to the right hemisphere to develop (Le Grand et al.,  2003 ; Maurer, Mondloch, & Lewis,  2007 ). The longer cataract surgery is postponed beyond infancy, the less complete the recovery in visual skills. And if surgery is delayed until adulthood, vision is severely and permanently impaired (Lewis & Maurer,  2005 ).

Studies of infants placed in orphanages who were later exposed to ordinary family rearing confirm the importance of a generally stimulating physical and social environment for psychological development. In one investigation, researchers followed the progress of a large sample of children transferred between birth and 3½ years from extremely deprived Romanian orphanages to adoptive families in Great Britain (Beckett et al.,  2006 ; O’Connor et al.,  2000 ; Rutter et al.,  1998 ,  2004 ,  2010 ). On arrival, most were impaired in all domains of development. Cognitive catch-up was impressive for children adopted before 6 months, who attained average mental test scores in childhood and adolescence, performing as well as a comparison group of early-adopted British-born children.

These children in an orphanage in Romania receive little adult contact or stimulation. The longer they remain in this barren environment, the more likely they are to display profound impairments in all domains of development.

But Romanian children who had been institutionalized for more than the first six months showed serious intellectual deficits (see  Figure 4.6 ). Although they improved in test scores during middle childhood and adolescence, they remained substantially below average. And most displayed at least three serious mental health problems, such as inattention, overactivity, unruly behavior, and autistic-like symptoms (social disinterest, stereotyped behavior) (Kreppner et al.,  2007 ,  2010 ).

Biology and Environment Brain Plasticity: Insights from Research on Brain-Damaged Children and Adults

This preschooler, who experienced brain damage in infancy, has been spared massive impairments because of early, high brain plasticity. A teacher guides his hand in drawing shapes to strengthen spatial skills, which are more impaired than language.

In the first few years of life, the brain is highly plastic. It can reorganize areas committed to specific functions in ways that the mature brain cannot. Consistently, adults who suffered brain injuries in infancy and early childhood show fewer cognitive impairments than adults with later-occurring injuries (Holland,  2004 ; Huttenlocher,  2002 ). Nevertheless, the young brain is not totally plastic. When it is injured, its functioning is compromised. The extent of plasticity depends on several factors, including age at time of injury, site of damage, and skill area. Furthermore, plasticity is not restricted to childhood. Some reorganization after injury also occurs in the mature brain.

Brain Plasticity in Infancy and Early Childhood

In a large study of children with injuries to the cerebral cortex that occurred before birth or in the first six months of life, language and spatial skills were assessed repeatedly into adolescence (Akshoomoff et al.,  2002 ; Stiles,  2001a ; Stiles et al.,  2005 ,  2008 ). All the children had experienced early brain seizures or hemorrhages. Brain-imaging techniques (fMRI and PET) revealed the precise site of damage.

Regardless of whether injury occurred in the left or right cerebral hemisphere, the children showed delays in language development that persisted until about 3½ years of age. That damage to either hemisphere affected early language competence indicates that at first, language functioning is broadly distributed in the brain. But by age 5, the children caught up in vocabulary and grammatical skills. Undamaged areas—in either the left or the right hemisphere—had taken over these language functions.

Compared with language, spatial skills were more impaired after early brain injury. When preschool through adolescent-age youngsters were asked to copy designs, those with early right-hemispheric damage had trouble with holistic processing—accurately representing the overall shape. In contrast, children with left-hemispheric damage captured the basic shape but omitted fine-grained details. Nevertheless, the children improved in drawing skills with age—gains that do not occur in brain-injured adults (Akshoomoff et al.,  2002 ; Stiles et al.,  2003 ,  2008 ).

Clearly, recovery after early brain injury is greater for language than for spatial skills. Why is this so? Researchers speculate that spatial processing is the older of the two capacities in our evolutionary history and, therefore, more lateralized at birth (Stiles,  2001b ; Stiles et al.,  2002 ,  2008 ). But early brain injury has far less impact than later injury on both language and spatial skills. In sum, the young brain is remarkably plastic.

The Price of High Plasticity in the Young Brain

Despite impressive recovery of language and (to a lesser extent) spatial skills, children with early brain injuries show deficits in a wide range of complex mental abilities during the school years. For example, their reading and math progress is slow. And in telling stories, they produce simpler narratives than agemates without early brain injuries (although many catch up in narrative skills by early adolescence) (Reilly, Bates, & Marchman,  1998 ; Reilly et al.,  2004 ). Furthermore, the more brain tissue destroyed in infancy or early childhood, the poorer children score on intelligence tests (Anderson et al.,  2006 ).

High brain plasticity, researchers explain, comes at a price. When healthy brain regions take over the functions of damaged areas, a “crowding effect” occurs: Multiple tasks must be done by a smaller-than-usual volume of brain tissue (Stiles,  2012 ). Consequently, the brain processes information less quickly and accurately than it would if it were intact. Complex mental abilities of all kinds suffer into middle childhood, and often longer, because performing them well requires considerable space in the cerebral cortex.

Brain Plasticity in Adulthood

Brain plasticity is not restricted to early childhood. Though far more limited, reorganization in the brain can occur later, even in adulthood. For example, adult stroke victims often display considerable recovery, especially in response to stimulation of language and motor skills. Brain-imaging techniques reveal that structures adjacent to the permanently damaged area or in the opposite cerebral hemisphere reorganize to support the impaired ability (Kalra & Ratan,  2007 ; Murphy & Corbett,  2009 ).

In infancy and childhood, the goal of brain growth is to form neural connections that ensure mastery of essential skills. Animal research reveals that plasticity is greatest while the brain is forming many new synapses; it declines during synaptic pruning (Murphy & Corbett,  2009 ). At older ages, specialized brain structures are in place, but after injury they can still reorganize to some degree. The adult brain can produce a small number of new neurons. And when an individual practices relevant tasks, the brain strengthens existing synapses and generates new ones (Nelson, Thomas, & de Haan,  2006 ).

Plasticity seems to be a basic property of the nervous system. Researchers hope to discover how experience and brain plasticity work together throughout life, so they can help people of all ages—with and without brain injuries—develop at their best.

FIGURE 4.6 Relationship of age at adoption to mental test scores at ages 6 and 11 among British and Romanian adoptees.

Children transferred from Romanian orphanages to British adoptive homes in the first six months of life attained average scores and fared as well as British early-adopted children, suggesting that they had fully recovered from extreme early deprivation. Romanian children adopted after 6 months of age performed well below average. And although those adopted after age 2 improved between ages 6 and 11, they continued to show serious intellectual deficits.

(Adapted from Beckett et al., 2006.)

Neurobiological findings indicate that early, prolonged institutionalization leads to a generalized decrease in activity in the cerebral cortex, especially the prefrontal cortex, which governs complex cognition and impulse control. Neural fibers connecting the prefrontal cortex with other brain structures involved in control of emotion are also reduced (Eluvathingal et al.,  2006 ; Nelson,  2007b ). And activation of the left cerebral hemisphere, governing positive emotion, is diminished relative to right cerebral activation, governing negative emotion (McLaughlin et al.,  2011 ).

Additional evidence confirms that the chronic stress of early, deprived orphanage rearing disrupts the brain’s capacity to manage stress, with long-term physical and psychological consequences. In another investigation, researchers followed the development of children who had spent their first eight months or more in Romanian institutions and were then adopted into Canadian homes (Gunnar et al.,  2001 ; Gunnar & Cheatham,  2003 ). Compared with agemates adopted shortly after birth, these children showed extreme stress reactivity, as indicated by high concentrations of the stress hormone cortisol in their saliva—a physiological response linked to persistent illness, retarded physical growth, and learning and behavior problems, including deficits in attention and control of anger and other impulses. The longer the children spent in orphanage care, the higher their cortisol levels—even 6½ years after adoption. In other investigations, orphanage children displayed abnormally low cortisol—a blunted physiological stress response that may be the central nervous system’s adaptation to earlier, frequent cortisol elevations (Loman & Gunnar,  2010 ).

Appropriate Stimulation.

Unlike the orphanage children just described, Grace, whom Monica and Kevin had adopted in Cambodia at 16 months of age, showed favorable progress. Two years earlier, they had adopted Grace’s older brother, Eli. When Eli was 2 years old, Monica and Kevin sent a letter and a photo of Eli to his biological mother, describing a bright, happy child. The next day, the Cambodian mother tearfully asked an adoption agency to send her baby daughter to join Eli and his American family. Although Grace’s early environment was very depleted, her biological mother’s loving care—holding gently, speaking softly, playfully stimulating, and breastfeeding—may have prevented irreversible damage to her brain.

In the Bucharest Early Intervention Project, about 200 institutionalized Romanian babies were randomized into conditions of either care as usual or transfer to high-quality foster families between ages 5 and 30 months. Specially trained social workers provided foster parents with counseling and support. Follow-ups between 2½ and 4 years revealed that the foster-care group exceeded the institutional-care group in intelligence test scores, language skills, emotional responsiveness, and EEG and ERP assessments of brain activity (Nelson et al.,  2007 ; Smyke et al.,  2009 ). On all measures, the earlier the foster placement, the better the outcome. But consistent with an early sensitive period, the foster-care group remained behind never-institutionalized agemates living with Bucharest families.

In addition to impoverished environments, ones that overwhelm children with expectations beyond their current capacities interfere with the brain’s potential. In recent years, expensive early learning centers have sprung up, in which infants are trained with letter and number flash cards and slightly older toddlers are given a full curriculum of reading, math, science, art, gym, and more. There is no evidence that these programs yield smarter “superbabies” (Hirsh-Pasek & Golinkoff,  2003 ). To the contrary, trying to prime infants with stimulation for which they are not ready can cause them to withdraw, thereby threatening their interest in learning and creating conditions much like stimulus deprivation!

How, then, can we characterize appropriate stimulation during the early years? To answer this question, researchers distinguish between two types of brain development. The first,  experience-expectant brain growth , refers to the young brain’s rapidly developing organization, which depends on ordinary experiences—opportunities to explore the environment, interact with people, and hear language and other sounds. As a result of millions of years of evolution, the brains of all infants, toddlers, and young children expect to encounter these experiences and, if they do, grow normally. The second type of brain development,  experience-dependent brain growth , occurs throughout our lives. It consists of additional growth and refinement of established brain structures as a result of specific learning experiences that vary widely across individuals and cultures (Greenough & Black,  1992 ). Reading and writing, playing computer games, weaving an intricate rug, and practicing the violin are examples. The brain of a violinist differs in certain ways from the brain of a poet because each has exercised different brain regions for a long time.

Experience-expectant brain growth occurs early and naturally, as caregivers offer babies and preschoolers age-appropriate play materials and engage them in enjoyable daily routines—a shared meal, a game of peekaboo, a bath before bed, a picture book to talk about, or a song to sing. The resulting growth provides the foundation for later-occurring, experience-dependent development (Huttenlocher,  2002 ; Shonkoff & Phillips,  2001 ). No evidence exists for a sensitive period in the first five or six years for mastering skills that depend on extensive training, such as reading, musical performance, or gymnastics. To the contrary, rushing early learning harms the brain by overwhelming its neural circuits, thereby reducing the brain’s sensitivity to the everyday experiences it needs for a healthy start in life.

Experience-expectant brain growth occurs naturally, through ordinary, stimulating experiences. This toddler exploring a mossy log enjoys the type of activity that best promotes brain development in the early years.

Changing States of Arousal

Rapid brain growth means that the organization of sleep and wakefulness changes substantially between birth and 2 years, and fussiness and crying also decline. The newborn baby takes round-the-clock naps that total about 16 to 18 hours (Davis, Parker & Montgomery,  2004 ). Total sleep time declines slowly; the average 2-year-old still needs 12 to 13 hours. But periods of sleep and wakefulness become fewer and longer, and the sleep–wake pattern increasingly conforms to a night–day schedule. Most 6- to 9-month-olds take two daytime naps; by about 18 months, children generally need only one nap. Finally, between ages 3 and 5, napping subsides (Iglowstein et al.,  2003 ).

These changing arousal patterns are due to brain development, but they are also affected by cultural beliefs and practices and individual parents’ needs (Super & Harkness,  2002 ). Dutch parents, for example, view sleep regularity as far more important than the U.S. parents do. And whereas U.S. parents regard a predictable sleep schedule as emerging naturally from within the child, Dutch parents believe that a schedule must be imposed, or the baby’s development might suffer (Super et al.,  1996 ; Super & Harkness,  2010 ). At age 6 months, Dutch babies are put to bed earlier and sleep, on average, 2 hours more per day than their U.S. agemates.

Motivated by demanding work schedules and other needs, many Western parents try to get their babies to sleep through the night as early as 3 to 4 months by offering an evening feeding—a practice that may be at odds with young infants’ neurological capacities. Not until the middle of the first year is the secretion of melatonin, a hormone within the brain that promotes drowsiness, much greater at night than during the day (Sadeh,  1997 ).

Furthermore, as the Cultural Influences box on the following page reveals, isolating infants to promote sleep is rare elsewhere in the world. When babies sleep with their parents, their average sleep period remains constant at three hours from 1 to 8 months of age. Only at the end of the first year, as REM sleep (the state that usually prompts waking) declines, do infants move in the direction of an adultlike sleep–waking schedule (Ficca et al.,  1999 ).

Even after infants sleep through the night, they continue to wake occasionally. In studies carried out in Australia, Israel, and the United States, night wakings increased around 6 months and again between 1½ and 2 years and then declined (Armstrong, Quinn, & Dadds,  1994 ; Scher, Epstein, & Tirosh,  2004 ; Scher et al.,  1995 ). As  Chapter 6  will reveal, around the middle of the first year, infants are forming a clear-cut attachment to their familiar caregiver and begin protesting when he or she leaves. And the challenges of toddlerhood—the ability to range farther from the caregiver and increased awareness of the self as separate from others—often prompt anxiety, evident in disturbed sleep and clinginess. When parents offer comfort, these behaviors subside.

LOOK AND LISTEN

Interview a parent of a baby about sleep challenges. What strategies has the parent tried to ease these difficulties? Are the techniques likely to be effective, in view of evidence on infant sleep development?

Cultural Influences Cultural Variation in Infant Sleeping Arrangements

This Vietnamese mother and child sleep together—a practice common in their culture and around the globe. Hard wooden sleeping surfaces protect cosleeping children from entrapment in soft bedding.

Western child-rearing advice from experts strongly encourages nighttime separation of baby from parent. For example, the most recent edition of Benjamin Spock’s Baby and Child Care recommends that babies sleep in their own room by 3 months of age, explaining, “By 6 months, a child who regularly sleeps in her parents’ room may feel uneasy sleeping anywhere else” (Spock & Needlman,  2012 , p. 62). And the American Academy of Pediatrics ( 2012 ) has issued a controversial warning that parent–infant bedsharing may increase the risk of sudden infant death syndrome (SIDS).

Yet parent–infant “cosleeping” is the norm for approximately 90 percent of the world’s population, in cultures as diverse as the Japanese, the rural Guatemalan Maya, the Inuit of northwestern Canada, and the !Kung of Botswana. Japanese and Korean children usually lie next to their mothers in infancy and early childhood, and many continue to sleep with a parent or other family member until adolescence (Takahashi,  1990 ; Yang & Hahn,  2002 ). Among the Maya, mother–infant bed-sharing is interrupted only by the birth of a new baby, when the older child is moved next to the father or to another bed in the same room (Morelli et al.,  1992 ). Bedsharing is also common in U.S. ethnic minority families (McKenna & Volpe,  2007 ). African-American children, for example, frequently fall asleep with their parents and remain with them for part or all of the night (Buswell & Spatz,  2007 ).

Cultural values—specifically, collectivism versus individualism (see  Chapter 2 )—strongly influence infant sleeping arrangements. In one study, researchers interviewed Guatemalan Mayan mothers and American middle-SES mothers about their sleeping practices. Mayan mothers stressed the importance of promoting an interdependent self, explaining that cosleeping builds a close parent–child bond, which is necessary for children to learn the ways of people around them. In contrast, American mothers emphasized an independent self, mentioning their desire to instill early autonomy, prevent bad habits, and protect their own privacy (Morelli et al.,  1992 ).

Over the past two decades, cosleeping has increased in Western nations. An estimated 13 percent of U.S. infants routinely bedshare, and an additional 30 to 35 percent some-times do (Buswell & Spatz,  2007 ; Willinger et al.,  2003 ). Proponents of the practice say that it helps infants sleep, makes breastfeeding more convenient, and provides valuable bonding time (McKenna & Volpe,  2007 ).

During the night, cosleeping babies breastfeed three times longer than infants who sleep alone. Because infants arouse to nurse more often when sleeping next to their mothers, some researchers believe that cosleeping may actually help safeguard babies at risk for SIDS (see  page 110  in  Chapter 3 ). Consistent with this view, SIDS is rare in Asian cultures where cosleeping is widespread, including Cambodia, China, Japan, Korea, Thailand, and Vietnam (McKenna,  2002 ; McKenna & McDade,  2005 ). And contrary to popular belief, cosleeping does not reduce mothers’ total sleep time, although they experience more brief awakenings, which permit them to check on their baby (Mao et al.,  2004 ).

Infant sleeping practices affect other aspects of family life. For example, Mayan babies doze off in the midst of ongoing family activities and are carried to bed by their mothers. In contrast, for many American parents, bedtime often involves a lengthy, elaborate ritual. Perhaps bedtime struggles, so common in Western homes but rare elsewhere in the world, are related to the stress young children feel when they must fall asleep without assistance (Latz, Wolf, & Lozoff,  1999 ).

Critics warn that bedsharing will promote emotional problems, especially excessive dependency. Yet a study following children from the end of pregnancy through age 18 showed that young people who had bedshared in the early years were no different from others in any aspect of adjustment (Okami, Weisner, & Olmstead,  2002 ). Another concern is that infants might become trapped under the parent’s body or in soft bedding and suffocate. Parents who are obese or who use alcohol, tobacco, or illegal drugs do pose a serious risk to their sleeping babies, as does the use of quilts and comforters or an overly soft mattress (American Academy of Pediatrics,  2012 ; Willinger et al.,  2003 ).

But with appropriate precautions, parents and infants can cosleep safely (McKenna & Volpe,  2007 ). In cultures where cosleeping is widespread, parents and infants usually sleep with light covering on hard surfaces, such as firm mattresses, floor mats, and wooden planks, or infants sleep in a cradle or hammock next to the parents’ bed (McKenna,  2001 ,  2002 ). And when sharing the same bed, infants typically lie on their back or side facing the mother—positions that promote frequent, easy communication between parent and baby and arousal if breathing is threatened.

Finally, breastfeeding mothers usually assume a distinctive sleeping posture: They face the infant, with knees drawn up under the baby’s feet and arm above the baby’s head. Besides facilitating feeding, the position prevents the infant from sliding down under covers or up under pillows (Ball,  2006 ). Because this posture is also seen in female great apes while sharing sleeping nests with their infants, researchers believe it may have evolved to enhance infant safety.

ASK YOURSELF

REVIEW How do overproduction of synapses and synaptic pruning support infants’ and children’s ability to learn?

CONNECT Explain how inappropriate stimulation—either too little or too much—can impair cognitive and emotional development in the early years.

APPLY Which infant enrichment program would you choose: one that emphasizes gentle talking and touching and social games, or one that includes reading and number drills and classical music lessons? Explain.

REFLECT What is your attitude toward parent–infant cosleeping? Is it influenced by your cultural background? Explain.

Influences on Early Physical Growth

Physical growth, like other aspects of development, results from a complex interplay between genetic and environmental factors. Heredity, nutrition, and emotional well-being all affect early physical growth.

Heredity

Because identical twins are much more alike in body size than fraternal twins, we know that heredity is important in physical growth (Estourgie-van Burk et al.,  2006 ; Touwslager et al.,  2011 ). When diet and health are adequate, height and rate of physical growth are largely influenced by heredity. In fact, as long as negative environmental influences such as poor nutrition and illness are not severe, children and adolescents typically show catch-up growth—a return to a genetically influenced growth path once conditions improve. Still, the brain, the heart, the digestive system, and many other internal organs may be permanently compromised (Hales & Ozanne,  2003 ). (Recall the consequences of inadequate prenatal nutrition for long-term health, discussed on  page 92  in  Chapter 3 .)

Genetic makeup also affects body weight: The weights of adopted children correlate more strongly with those of their biological than of their adoptive parents (Kinnunen, Pietilainen, & Rissanen,  2006 ). At the same time, environment—in particular, nutrition—plays an especially important role.

Nutrition

Nutrition is especially crucial for development in the first two years because the baby’s brain and body are growing so rapidly. Pound for pound, an infant’s energy needs are twice those of an adult. Twenty-five percent of babies’ total caloric intake is devoted to growth, and infants need extra calories to keep rapidly developing organs functioning properly (Meyer,  2009 ).

Midwives in India support a mother as she learns to breastfeed her infant. Breastfeeding is especially important in developing countries, where it helps protect babies against life-threatening infections and early death.

Breastfeeding versus Bottle-Feeding.

Babies need not only enough food but also the right kind of food. In early infancy, breastfeeding is ideally suited to their needs, and bottled formulas try to imitate it. Applying What We Know on the following page summarizes major nutritional and health advantages of breastfeeding.

Because of these benefits, breastfed babies in poverty-stricken regions are much less likely to be malnourished and 6 to 14 times more likely to survive the first year of life. The World Health Organization recommends breastfeeding until age 2 years, with solid foods added at 6 months. These practices, if widely followed, would save the lives of more than a million infants annually (World Health Organization,  2012b ). Even breastfeeding for just a few weeks offers some protection against respiratory and intestinal infections, which are devastating to young children in developing countries. Also, because a nursing mother is less likely to get pregnant, breastfeeding helps increase spacing between siblings, a major factor in reducing infant and childhood deaths in nations with widespread poverty. (Note, however, that breastfeeding is not a reliable method of birth control.)

Yet many mothers in the developing world do not know about these benefits. In Africa, the Middle East, and Latin America, most babies get some breastfeeding, but fewer than 40 percent are exclusively breastfed for the first six months, and one-third are fully weaned from the breast before 1 year (UNICEF,  2009 ). In place of breast milk, mothers give their babies commercial formula or low-grade nutrients, such as rice water or highly diluted cow or goat milk. Contamination of these foods as a result of poor sanitation is common and often leads to illness and infant death. The United Nations has encouraged all hospitals and maternity units in developing countries to promote breastfeeding as long as mothers do not have viral or bacterial infections (such as HIV or tuberculosis) that can be transmitted to the baby. Today, most developing countries have banned the practice of giving free or subsidized formula to new mothers.

Partly as a result of the natural childbirth movement, breastfeeding has become more common in industrialized nations, especially among well-educated women. Today, 74 percent of American mothers breastfeed, but more than half stop by 6 months (Centers for Disease Control and Prevention,  2011a ). Not surprisingly, mothers who return to work sooner wean their babies from the breast earlier (Kimbro,  2006 ). But mothers who cannot be with their infants all the time can still combine breast- and bottle-feeding. The U.S. Department of Health and Human Services ( 2010a ) advises exclusive breastfeeding for the first 6 months and inclusion of breast milk in the baby’s diet until at least 1 year.

Women who do not breastfeed sometimes worry that they are depriving their baby of an experience essential for healthy psychological development. Yet breastfed and bottle-fed infants in industrialized nations do not differ in quality of the mother–infant relationship or in later emotional adjustment (Fergusson & Woodward,  1999 ; Jansen, de Weerth, & Riksen-Walraven,  2008 ). Some studies report a slight advantage in intelligence test performance for children and adolescents who were breastfed, after controlling for many factors. Most, however, find no cognitive benefits (Der, Batty, & Deary,  2006 ).

Applying What We Know Reasons to Breastfeed

Nutritional and Health Advantages Explanation
Provides the correct balance of fat and protein Compared with the milk of other mammals, human milk is higher in fat and lower in protein. This balance, as well as the unique proteins and fats contained in human milk, is ideal for a rapidly myelinating nervous system.
Ensures nutritional completeness A mother who breastfeeds need not add other foods to her infant’s diet until the baby is 6 months old. The milks of all mammals are low in iron, but the iron contained in breast milk is much more easily absorbed by the baby’s system. Consequently, bottle-fed infants need iron-fortified formula.
Helps ensure healthy physical growth One-year-old breastfed babies are leaner (have a higher percentage of muscle to fat), a growth pattern that persists through the preschool years and that may help prevent later overweight and obesity.
Protects against many diseases Breastfeeding transfers antibodies and other infection-fighting agents from mother to child and enhances functioning of the immune system. Compared with bottle-fed infants, breastfed babies have far fewer allergic reactions and respiratory and intestinal illnesses. Breast milk also has anti-inflammatory effects, which reduce the severity of illness symptoms. Breastfeeding in the first four months is linked to lower blood cholesterol levels in adulthood and, thereby, may help prevent cardiovascular disease.
Protects against faulty jaw development and tooth decay Sucking the mother’s nipple instead of an artificial nipple helps avoid malocclusion, a condition in which the upper and lower jaws do not meet properly. It also protects against tooth decay due to sweet liquid remaining in the mouths of infants who fall asleep while sucking on a bottle.
Ensures digestibility Because breastfed babies have a different kind of bacteria growing in their intestines than do bottle-fed infants, they rarely suffer from constipation or other gastrointestinal problems.
Smooths the transition to solid foods Breastfed infants accept new solid foods more easily than bottle-fed infants, perhaps because of their greater experience with a variety of flavors, which pass from the maternal diet into the mother’s milk.

Sources: American Academy of Pediatrics, 2005; Buescher, 2001; Michels et al., 2007; Owen et al., 2008; Rosetta & Baldi, 2008; Weyermann, Rothenbacher, & Brenner, 2006.

Are Chubby Babies at Risk for Later Overweight and Obesity?

From early infancy, Timmy was an enthusiastic eater who nursed vigorously and gained weight quickly. By 5 months, he began reaching for food on his mother’s plate. Vanessa wondered: Was she overfeeding Timmy and increasing his chances of becoming overweight?

Most chubby babies thin out during toddlerhood and early childhood, as weight gain slows and they become more active. Infants and toddlers can eat nutritious foods freely without risk of becoming overweight. But recent evidence does indicate a strengthening relationship between rapid weight gain in infancy and later obesity (Botton et al.,  2008 ; Chomtho et al.,  2008 ). The trend may be due to the rise in overweight and obesity among adults, who promote unhealthy eating habits in their young children. Interviews with 1,500 U.S. parents of 4- to 24-month-olds revealed that many routinely served older infants and toddlers french fries, pizza, candy, sugary fruit drinks, and soda. On average, infants consumed 20 percent and toddlers 30 percent more calories than they needed. At the same time, as many as one-fourth ate no fruits and one-third no vegetables (Siega-Riz et al.,  2010 ).

How can concerned parents prevent their infants from becoming overweight children and adults? One way is to breastfeed for the first six months, which is associated with slower early weight gain (Gunnarsdottir et al.,  2010 ). Another is to avoid giving them foods loaded with sugar, salt, and saturated fats. Once toddlers learn to walk, climb, and run, parents can also provide plenty of opportunities for energetic play. Finally, because research shows a correlation between excessive television viewing and overweight in older children, parents should limit the time very young children spend in front of the TV.

Malnutrition

Osita is an Ethiopian 2-year-old whose mother has never had to worry about his gaining too much weight. When she weaned him at 1 year, there was little for him to eat besides starchy rice-flour cakes. Soon his belly enlarged, his feet swelled, his hair fell out, and a rash appeared on his skin. His bright-eyed curiosity vanished, and he became irritable and listless.

In developing countries and war-torn areas where food resources are limited, malnutrition is widespread. Recent evidence indicates that about 27 percent of the world’s children suffer from malnutrition before age 5 (World Health Organization,  2010 ). The 10 percent who are severely affected suffer from two dietary diseases.

Marasmus  is a wasted condition of the body caused by a diet low in all essential nutrients. It usually appears in the first year of life when a baby’s mother is too malnourished to produce enough breast milk and bottle-feeding is also inadequate. Her starving baby becomes painfully thin and is in danger of dying.

Osita has  kwashiorkor , caused by an unbalanced diet very low in protein. The disease usually strikes after weaning, between 1 and 3 years of age. It is common in regions where children get just enough calories from starchy foods but little protein. The child’s body responds by breaking down its own protein reserves, which causes the swelling and other symptoms that Osita experienced.

Children who survive these extreme forms of malnutrition grow to be smaller in all body dimensions and suffer from lasting damage to the brain, heart, liver, or other organs (Müller & Krawinkel,  2005 ). When their diets do improve, they tend to gain excessive weight (Uauy et al.,  2008 ). A malnourished body protects itself by establishing a low basal metabolism rate, which may endure after nutrition improves. Also, malnutrition may disrupt appetite control centers in the brain, causing the child to overeat when food becomes plentiful.

Learning and behavior are also seriously affected. In one long-term study of marasmic children, an improved diet led to some catch-up growth in height, but not in head size (Stoch et al.,  1982 ). The malnutrition probably interfered with growth of neural fibers and myelination, causing a permanent loss in brain weight. And animal evidence reveals that a deficient diet alters the production of neurotransmitters in the brain—an effect that can disrupt all aspects of development (Haller,  2005 ). These children score low on intelligence tests, show poor fine-motor coordination, and have difficulty paying attention (Galler et al.,  1990 ; Liu et al.,  2003 ). They also display a more intense stress response to fear-arousing situations, perhaps caused by the constant, gnawing pain of hunger (Fernald & Grantham-McGregor,  1998 ).

Inadequate nutrition is not confined to developing countries. Because government-supported supplementary food programs do not reach all families in need, an estimated 21 percent of U.S. children suffer from food insecurity—uncertain access to enough food for a healthy, active life. Food insecurity is especially high among single-parent families (35 percent) and low-income ethnic minority families—for example, Hispanics and African Americans (25 and 27 percent, respectively) (U.S. Department of Agriculture,  2011a ). Although few of these children have marasmus or kwashiorkor, their physical growth and ability to learn are still affected.

Left photo: This baby of Niger, Africa, has marasmus, a wasted condition caused by a diet low in all essential nutrients. Right photo: The swollen abdomen of this toddler, also of Niger, is a symptom of kwashiorkor, which results from a diet very low in protein. If these children survive, they are likely to be growth stunted and to suffer from lasting organ damage and serious cognitive and emotional impairments.

ASK YOURSELF

REVIEW Explain why breastfeeding can have lifelong consequences for the development of babies born in poverty-stricken regions of the world.

CONNECT How are bidirectional influences between parent and child involved in the impact of malnutrition on psychological development?

APPLY Eight-month-old Shaun is well below average in height and painfully thin. What serious growth disorder does he likely have, and what type of intervention, in addition to dietary enrichment, will help restore his development? (Hint: See  page 92  in  Chapter 3 .)

REFLECT Imagine that you are the parent of a newborn baby. Describe feeding practices you would use, and ones you would avoid, to prevent overweight and obesity.

Learning Capacities

Learning refers to changes in behavior as the result of experience. Babies come into the world with built-in learning capacities that permit them to profit from experience immediately. Infants are capable of two basic forms of learning, which were introduced in  Chapter 1 : classical and operant conditioning. They also learn through their natural preference for novel stimulation. Finally, shortly after birth, babies learn by observing others; they can imitate the facial expressions and gestures of adults.

FIGURE 4.7 The steps of classical conditioning.

This example shows how a mother classically conditioned her baby to make sucking movements by stroking the baby’s forehead at the beginning of feedings.

Classical Conditioning

Newborn reflexes, discussed in  Chapter 3 , make  classical conditioning  possible in the young infant. In this form of learning, a neutral stimulus is paired with a stimulus that leads to a reflexive response. Once the baby’s nervous system makes the connection between the two stimuli, the neutral stimulus produces the behavior by itself. Classical conditioning helps infants recognize which events usually occur together in the everyday world, so they can anticipate what is about to happen next. As a result, the environment becomes more orderly and predictable. Let’s take a closer look at the steps of classical conditioning.

As Carolyn settled down in the rocking chair to nurse Caitlin, she often stroked Caitlin’s forehead. Soon Carolyn noticed that each time she did this, Caitlin made sucking movements. Caitlin had been classically conditioned.  Figure 4.7  shows how it happened:

· 1. Before learning takes place, an  unconditioned stimulus (UCS)  must consistently produce a reflexive, or  unconditioned, response (UCR) . In Caitlin’s case, sweet breast milk (UCS) resulted in sucking (UCR).

· 2. To produce learning, a neutral stimulus that does not lead to the reflex is presented just before, or at about the same time as, the UCS. Carolyn stroked Caitlin’s forehead as each nursing period began. The stroking (neutral stimulus) was paired with the taste of milk (UCS).

· 3. If learning has occurred, the neutral stimulus by itself produces a response similar to the reflexive response. The neutral stimulus is then called a  conditioned stimulus (CS) , and the response it elicits is called a  conditioned response (CR) . We know that Caitlin has been classically conditioned because stroking her forehead outside the feeding situation (CS) results in sucking (CR).

If the CS is presented alone enough times, without being paired with the UCS, the CR will no longer occur, an outcome called extinction. In other words, if Carolyn repeatedly strokes Caitlin’s forehead without feeding her, Caitlin will gradually stop sucking in response to stroking.

Young infants can be classically conditioned most easily when the association between two stimuli has survival value. In the example just described, learning which stimuli regularly accompany feeding improves the infant’s ability to get food and survive (Blass, Ganchrow, & Steiner,  1984 ).

In contrast, some responses, such as fear, are very difficult to classically condition in young babies. Until infants have the motor skills to escape unpleasant events, they have no biological need to form these associations. After age 6 months, however, fear is easy to condition. In  Chapter 6 , we will discuss the development of fear and other emotional reactions.

Operant Conditioning

In classical conditioning, babies build expectations about stimulus events in the environment, but their behavior does not influence the stimuli that occur. In  operant conditioning , infants act, or operate, on the environment, and stimuli that follow their behavior change the probability that the behavior will occur again. A stimulus that increases the occurrence of a response is called a  reinforcer . For example, sweet liquid reinforces the sucking response in newborns. Removing a desirable stimulus or presenting an unpleasant one to decrease the occurrence of a response is called  punishment . A sour-tasting fluid punishes newborns’ sucking response, causing them to purse their lips and stop sucking entirely.

Many stimuli besides food can serve as reinforcers of infant behavior. For example, newborns will suck faster on a nipple when their rate of sucking produces interesting sights and sounds, including visual designs, music, or human voices (Floccia, Christophe, & Bertoncini,  1997 ). As these findings suggest, operant conditioning is a powerful tool for finding out what stimuli babies can perceive and which ones they prefer.

As infants get older, operant conditioning includes a wider range of responses and stimuli. For example, researchers have hung mobiles over the cribs of 2- to 6-month-olds. When the baby’s foot is attached to the mobile with a long cord, the infant can, by kicking, make the mobile turn. Under these conditions, it takes only a few minutes for infants to start kicking vigorously (Rovee-Collier,  1999 ; Rovee-Collier & Barr,  2001 ). As you will see in  Chapter 5 , operant conditioning with mobiles is frequently used to study infants’ memory and their ability to group similar stimuli into categories. Once babies learn the kicking response, researchers see how long and under what conditions they retain it when exposed again to the original mobile or to mobiles with varying features.

Operant conditioning also plays a vital role in the formation of social relationships. As the baby gazes into the adult’s eyes, the adult looks and smiles back, and then the infant looks and smiles again. As the behavior of each partner reinforces the other, both continue their pleasurable interaction. In  Chapter 6 , we will see that this contingent responsiveness contributes to the development of infant–caregiver attachment.

Habituation

At birth, the human brain is set up to be attracted to novelty. Infants tend to respond more strongly to a new element that has entered their environment, an inclination that ensures that they will continually add to their knowledge base.  Habituation  refers to a gradual reduction in the strength of a response due to repetitive stimulation. Looking, heart rate, and respiration rate may all decline, indicating a loss of interest. Once this has occurred, a new stimulus—a change in the environment—causes responsiveness to return to a high level, an increase called  recovery . For example, when you walk through a familiar space, you notice things that are new and different—a recently hung picture on the wall or a piece of furniture that has been moved. Habituation and recovery make learning more efficient by focusing our attention on those aspects of the environment we know least about.

Researchers investigating infants’ understanding of the world rely on habituation and recovery more than any other learning capacity. For example, a baby who first habituates to a visual pattern (a photo of a baby) and then recovers to a new one (a photo of a bald man) appears to remember the first stimulus and perceive the second one as new and different from it. This method of studying infant perception and cognition, illustrated in  Figure 4.8 , can be used with newborns, including preterm infants (Kavšek & Bornstein,  2010 ). It has even been used to study the fetus’s sensitivity to external stimuli—for example, by measuring changes in fetal heart rate when various repeated sounds are presented (see  page 85  in  Chapter 3 ).

Recovery to a new stimulus, or novelty preference, assesses infants’ recent memory.  TAKE A MOMENT… Think about what happens when you return to a place you have not seen for a long time. Instead of attending to novelty, you are likely to focus on aspects that are familiar: “I recognize that—I’ve been here before!” Like adults, infants shift from a novelty preference to a familiarity preference as more time intervenes between habituation and test phases in research. That is, babies recover to the familiar stimulus rather than to a novel stimulus (see  Figure 4.8 ) (Bahrick, Hernandez-Reif, & Pickens,  1997 ; Courage & Howe,  1998 ; Flom & Bahrick,  2010 ; Richmond, Colombo, & Hayne,  2007 ). By focusing on that shift, researchers can also use habituation to assess remote memory, or memory for stimuli to which infants were exposed weeks or months earlier.

As  Chapter 5  will reveal, habituation research has greatly enriched our understanding of how long babies remember a wide range of stimuli. And by varying stimulus features, researchers can use habituation and recovery to study babies’ ability to categorize stimuli as well.

FIGURE 4.8 Using habituation to study infant perception and cognition.

In the habituation phase, infants view a photo of a baby until their looking declines. In the test phase, infants are again shown the baby photo, but this time it appears alongside a photo of a bald-headed man. (a) When the test phase occurs soon after the habituation phase (within minutes, hours, or days, depending on the age of the infants), participants who remember the baby face and distinguish it from the man’s face show a novelty preference; they recover to (spend more time looking at) the new stimulus. (b) When the test phase is delayed for weeks or months, infants who continue to remember the baby face shift to a familiarity preference; they recover to the familiar baby face rather than to the novel man’s face.

Imitation

Babies come into the world with a primitive ability to learn through  imitation —by copying the behavior of another person. For example,  Figure 4.9  shows a human newborn imitating two adult facial expressions (Meltzoff & Moore,  1977 ). The newborn’s capacity to imitate extends to certain gestures, such as head and index-finger movements, and has been demonstrated in many ethnic groups and cultures (Meltzoff & Kuhl,  1994 ; Nagy et al.,  2005 ). As the figure illustrates, even newborn primates, including chimpanzees (our closest evolutionary relatives), imitate some behaviors (Ferrari et al.,  2006 ; Myowa-Yamakoshi et al.,  2004 ).

FIGURE 4.9 Imitation by human and chimpanzee newborns.

The human infants in the middle row imitating (left) tongue protrusion and (right) mouth opening are 2 to 3 weeks old. The chimpanzee imitating both facial expressions is 2 weeks old.

(From A. N. Meltzoff & M. K. Moore, 1977, “Imitation of Facial and Manual Gestures by Human Neonates,” Science, 198, p. 75. Copyright © 1977 by AAAS. Reprinted with permission of the AAAS and A. N. Meltzoff. And from M. Myowa-Yamakoshi et al., 2004, “Imitation in Neonatal Chimpanzees [Pan Troglodytes].” Developmental Science, 7, p. 440. Copyright 2004 by Blackwell Publishing. Reproduced with permission of John Wiley & Sons Ltd.)

Although newborns’ capacity to imitate is widely accepted, a few studies have failed to reproduce the human findings (see, for example, Anisfeld et al.,  2001 ). And because newborn mouth and tongue movements occur with increased frequency to almost any arousing change in stimulation (such as lively music or flashing lights), some researchers argue that certain newborn “imitative” responses are actually mouthing—a common early exploratory response to interesting stimuli (Jones,  2009 ). Furthermore, imitation is harder to induce in babies 2 to 3 months old than just after birth. Therefore, skeptics believe that the newborn imitative capacity is little more than an automatic response that declines with age, much like a reflex (Heyes,  2005 ).

Others claim that newborns—both primates and humans—imitate a variety of facial expressions and head movements with effort and determination, even after short delays—when the adult is no longer demonstrating the behavior (Meltzoff & Moore,  1999 ; Paukner, Ferrari, & Suomi,  2011 ). Furthermore, these investigators argue that imitation—unlike reflexes—does not decline. Human babies several months old often do not imitate an adult’s behavior right away because they first try to play familiar social games—mutual gazing, cooing, smiling, and waving their arms. But when an adult models a gesture repeatedly, older human infants soon get down to business and imitate (Meltzoff & Moore,  1994 ). Similarly, imitation declines in baby chimps around 9 weeks of age, when mother–baby mutual gazing and other face-to-face exchanges increase.

According to Andrew Meltzoff, newborns imitate much as older children and adults do—by actively trying to match body movements they see with ones they feel themselves make (Meltzoff,  2007 ). Later we will encounter evidence that young infants are remarkably adept at coordinating information across sensory systems.

Indeed, scientists have identified specialized cells in motor areas of the cerebral cortex in primates—called  mirror neurons —that underlie these capacities (Ferrari & Coudé,  2011 ). Mirror neurons fire identically when a primate hears or sees an action and when it carries out that action on its own(Rizzolatti & Craighero,  2004 ). Human adults have especially elaborate systems of mirror neurons, which enable us to observe another’s behavior (such as smiling or throwing a ball) while simulating the behavior in our own brain. Mirror neurons are believed to be the biological basis of a variety of interrelated, complex social abilities, including imitation, empathic sharing of emotions, and understanding others’ intentions (Iacoboni,  2009 ; Schulte-Ruther et al.,  2007 ).

Brain-imaging findings support a functioning mirror-neuron system as early as 6 months of age. Using NIRS, researchers found that the same motor areas of the cerebral cortex were activated in 6-month-olds and in adults when they observed a model engage in a behavior that could be imitated (tapping a box to make a toy pop out) as when they themselves engaged in the motor action (Shimada & Hiraki,  2006 ). In contrast, when infants and adults observed an object that appeared to move on its own, without human intervention (a ball hanging from the ceiling on a string, swinging like a pendulum), motor areas were not activated.

Still, Meltzoff’s view of newborn imitation as a flexible, voluntary capacity remains controversial. Mirror neurons, though possibly functional at birth, undergo an extended period of development (Bertenthal & Longo,  2007 ; Lepage & Théoret,  2007 ). Similarly, as we will see in  Chapter 5 , the capacity to imitate expands greatly over the first two years. But however limited it is at birth, imitation is a powerful means of learning. Using imitation, infants explore their social world, not only learning from other people but getting to know them by matching their behavioral states. As babies notice similarities between their own actions and those of others, they experience other people as “like me” and, thus, learn about themselves (Meltzoff,  2007 ). In this way, infant imitation may serve as the foundation for understanding others’ thoughts and feelings, which we take up in  Chapter 6 . Finally, caregivers take great pleasure in a baby who imitates their facial gestures and actions, which helps get the infant’s relationship with parents off to a good start.

ASK YOURSELF

REVIEW Provide an example of classical conditioning, of operant conditioning, and of habituation/recovery in young infants. Why is each type of learning useful?

CONNECT Which learning capacities contribute to an infant’s first social relationships? Explain, providing examples.

APPLY Nine-month-old Byron has a toy with large, colored push buttons on it. Each time he pushes a button, he hears a nursery tune. Which learning capacity is the manufacturer of this toy taking advantage of? What can Byron’s play with the toy reveal about his perception of sound patterns?

Motor Development

Carolyn, Monica, and Vanessa each kept a baby book, filled with proud notations about when their children first held up their heads, reached for objects, sat by themselves, and walked alone. Parents are understandably excited about these new motor skills, which allow babies to master their bodies and the environment in new ways. For example, sitting upright gives infants a new perspective on the world. Reaching permits babies to find out about objects by acting on them. And when infants can move on their own, their opportunities for exploration multiply.

Babies’ motor achievements have a powerful effect on their social relationships. When Caitlin crawled at 7½ months, Carolyn and David began to restrict her movements by saying no and expressing mild impatience. When she walked three days after her first birthday, the first “testing of wills” occurred (Biringen et al.,  1995 ). Despite her mother’s warnings, she sometimes pulled items from shelves that were off limits. “I said, ‘Don’t do that!’” Carolyn would say firmly, taking Caitlin’s hand and redirecting her attention.

At the same time, newly walking babies more actively attend to and initiate social interaction (Clearfield, Osborn, & Mullen,  2008 ; Karasik et al.,  2011 ). Caitlin frequently toddled over to her parents to express a greeting, give a hug, or show them objects of interest. Carolyn and David, in turn, increased their expressions of affection and playful activities. And when Caitlin encountered risky situations, such as a sloping walkway or a dangerous object, Carolyn and David intervened, combining emotional warnings with rich verbal and gestural information that helped Caitlin notice critical features of her surroundings, regulate her motor actions, and acquire language (Campos et al.,  2000 ; Karasik et al.,  2008 ). Caitlin’s delight as she worked on new motor skills triggered pleasurable reactions in others, which encouraged her efforts further. Motor, social, cognitive, and language competencies developed together and supported one another.

The Sequence of Motor Development

Gross-motor development refers to control over actions that help infants get around in the environment, such as crawling, standing, and walking. Fine-motor development has to do with smaller movements, such as reaching and grasping.  Table 4.2  shows the average age at which U.S. infants and toddlers achieve a variety of gross- and fine-motor skills. It also presents the age ranges during which most babies accomplish each skill, indicating large individual differences in rate of motor progress. Also, a baby who is a late reacher will not necessarily be a late crawler or walker. We would be concerned about a child’s development only if many motor skills were seriously delayed.

Historically, researchers assumed that motor skills were separate, innate abilities that emerged in a fixed sequence governed by a built-in maturational timetable. This view has long been discredited. Rather, motor skills are interrelated. Each is a product of earlier motor attainments and a contributor to new ones. And children acquire motor skills in highly individual ways. For example, before her adoption, Grace spent most of her days lying in a hammock. Because she was rarely placed on her tummy and on firm surfaces that enabled her to move on her own, she did not try to crawl. As a result, she pulled to a stand and walked before she crawled! Babies display such skills as rolling, sitting, crawling, and walking in diverse orders rather than in the sequence implied by motor norms (Adolph, Karasik, & Tamis-LeMonda,  2010 ).

TABLE 4.2 Gross- and Fine-Motor Development in the First Two Years

MOTOR SKILL AVERAGE AGE ACHIEVED AGE RANGE IN WHICH 90 PERCENT OF INFANTS ACHIEVE THE SKILL  
When held upright, holds head erect and steady 6 weeks 3 weeks–4 months    

image6

When prone, lifts self by arms 2 months 3 weeks–4 months    
Rolls from side to back 2 months 3 weeks–5 months    
Grasps cube 3 months, 3 weeks 2–7 months    
Rolls from back to side 4½ months 2–7 months    
Sits alone 7 months 5–9 months  

image7

 
Crawls 7 months 5–11 months    
Pulls to stand 8 months 5–12 months    
Plays pat-a-cake 9 months, 3 weeks 7–15 months    

image8

Stands alone 11 months 9–16 months    
Walks alone 11 months, 3 weeks 9–17 months    
Builds tower of two cubes 11 months, 3 weeks 10–19 months    
Scribbles vigorously 14 months 10–21 months    
Walks up stairs with help 16 months 12–23 months    
Jumps in place 23 months, 2 weeks 17–30 months    
Walks on tiptoe 25 months 16–30 months    

Note: These milestones represent overall age trends. Individual differences exist in the precise age at which each milestone is attained.

Sources: Bayley, 1969, 1993, 2005.

Photos: (top) © Laura Dwight Photography; (middle) © Laura Dwight Photography; (bottom) © Elizabeth Crews/The Image Works

Motor Skills as Dynamic Systems

According to  dynamic systems theory of motor development , mastery of motor skills involves acquiring increasingly complex systems of action. When motor skills work as a system, separate abilities blend together, each cooperating with others to produce more effective ways of exploring and controlling the environment. For example, control of the head and upper chest combine into sitting with support. Kicking, rocking on all fours, and reaching combine to become crawling. Then crawling, standing, and stepping are united into walking (Adolph & Berger,  2006 ; Thelen & Smith,  1998 ).

Each new skill is a joint product of four factors: (1) central nervous system development, (2) the body’s movement capacities, (3) the goals the child has in mind, and (4) environmental supports for the skill. Change in any element makes the system less stable, and the child starts to explore and select new, more effective motor patterns.

The broader physical environment also profoundly influences motor skills. Infants with stairs in their home learn to crawl up stairs at an earlier age and also more readily master a back-descent strategy—the safest but also the most challenging position because the baby must turn around at the top, give up visual guidance of her goal, and crawl backward (Berger, Theuring, & Adolph,  2007 ). And if children were reared on the moon, with its reduced gravity, they would prefer jumping to walking or running!

LOOK AND LISTEN

Spend an hour observing a newly crawling or walking baby. Note the goals that motivate the baby to move, along with the baby’s effort and motor experimentation. Describe parenting behaviors and features of the environment that promote mastery of the skill.

When a skill is first acquired, infants must refine it. For example, in trying to crawl, Caitlin often collapsed on her tummy and moved backward. Soon she figured out how to propel herself forward by alternately pulling with her arms and pushing with her feet, “belly-crawling” in various ways for several weeks (Vereijken & Adolph,  1999 ). As babies attempt a new skill, related, previously mastered skills often become less secure. As the novice walker experiments with balancing the body vertically over two small moving feet, balance during sitting may become temporarily less stable (Chen et al.,  2007 ). In learning to walk, toddlers practice six or more hours a day, traveling the length of 29 football fields! Gradually their small, unsteady steps change to a longer stride, their feet move closer together, their toes point to the front, and their legs become symmetrically coordinated (Adolph, Vereijken, & Shrout,  2003 ). As movements are repeated thousands of times, they promote new synaptic connections in the brain that govern motor patterns.

Dynamic systems theory shows us why motor development cannot be genetically determined. Because it is motivated by exploration and the desire to master new tasks, heredity can map it out only at a general level. Rather than being hardwired into the nervous system, behaviors are softly assembled, allowing for different paths to the same motor skill (Adolph,  2008 ; Thelen & Smith,  2006 ).

FIGURE 4.10 Reaching “feet first.”

When sounding toys were held in front of babies’ hands and feet, they reached with their feet as early as 8 weeks of age, a month or more before they reached with their hands. This 2½-month-old skillfully explores an object with her foot.

Dynamic Motor Systems in Action.

To find out how babies acquire motor capacities, some studies have tracked their first attempts at a skill until it became smooth and effortless. In one investigation, researchers held sounding toys alternately in front of infants’ hands and feet, from the time they showed interest until they engaged in well-coordinated reaching and grasping (Galloway & Thelen,  2004 ). As  Figure 4.10  shows, the infants violated the normative sequence of arm and hand control preceding leg and foot control, shown in  Table 4.2 . They first reached for the toys with their feet—as early as 8 weeks of age, at least a month before reaching with their hands!

Why did babies reach “feet first”? Because the hip joint constrains the legs to move less freely than the shoulder constrains the arms, infants could more easily control their leg movements. When they first tried reaching with their hands, their arms actually moved away from the object! Consequently, foot reaching required far less practice than hand reaching. As these findings confirm, rather than following a strict, predetermined pattern, the order in which motor skills develop depends on the anatomy of the body part being used, the surrounding environment, and the baby’s efforts.

Cultural Variations in Motor Development.

Cross-cultural research further illustrates how early movement opportunities and a stimulating environment contribute to motor development. Over half a century ago, Wayne Dennis ( 1960 ) observed infants in Iranian orphanages who were deprived of the tantalizing surroundings that induce infants to acquire motor skills. These babies spent their days lying on their backs in cribs, without toys to play with. As a result, most did not move on their own until after 2 years of age. When they finally did move, the constant experience of lying on their backs led them to scoot in a sitting position rather than crawl on their hands and knees. Because babies who scoot come up against furniture with their feet, not their hands, they are far less likely to pull themselves to a standing position in preparation for walking. Indeed, by 3 to 4 years of age, only 15 percent of the Iranian orphans were walking alone.

Cultural variations in infant-rearing practices affect motor development.  TAKE A MOMENT…  Take a quick survey of several parents you know: Should sitting, crawling, and walking be deliberately encouraged? Answers vary widely from culture to culture. Japanese mothers, for example, believe such efforts are unnecessary (Seymour,  1999 ). Among the Zinacanteco Indians of southern Mexico and the Gusii of Kenya, rapid motor progress is actively discouraged. Babies who walk before they know enough to keep away from cooking fires and weaving looms are viewed as dangerous to themselves and disruptive to others (Greenfield,  1992 ).

In contrast, among the Kipsigis of Kenya and the West Indians of Jamaica, babies hold their heads up, sit alone, and walk considerably earlier than North American infants. In both societies, parents emphasize early motor maturity, practicing formal exercises to stimulate particular skills (Adolph, Karasik, & Tamis-LeMonda,  2010 ). In the first few months, babies are seated in holes dug in the ground, with rolled blankets to keep them upright. Walking is promoted by frequently standing babies in adults’ laps, bouncing them on their feet, and exercising the stepping reflex (Hopkins & Westra,  1988 ; Super,  1981 ). As parents in these cultures support babies in upright postures and rarely put them down on the floor, their infants usually skip crawling—a motor skill regarded as crucial in Western nations!

Finally, because it decreases exposure to “tummy time,” the current Western practice of having babies sleep on their backs to protect them from SIDS (see  page 110  in  Chapter 3 ) delays gross motor milestones of rolling, sitting, and crawling (Majnemer & Barr,  2005 ; Scrutton,  2005 ). Regularly exposing infants to the tummy-lying position during waking hours prevents these delays.

This West Indian mother of Jamaica “walks” her baby up her body in a deliberate effort to promote early mastery of walking.

Fine-Motor Development: Reaching and Grasping

Of all motor skills, reaching may play the greatest role in infant cognitive development. By grasping things, turning them over, and seeing what happens when they are released, infants learn a great deal about the sights, sounds, and feel of objects.

FIGURE 4.11 Some milestones of reaching and grasping.

The average age at which each skill is attained is given. (Ages from Bayley,  1969 ; Rochat,  1989 .)

Reaching and grasping, like many other motor skills, start out as gross, diffuse activity and move toward mastery of fine movements.  Figure 4.11  illustrates some milestones of reaching over the first nine months. Newborns make poorly coordinated swipes or swings, called prereaching, toward an object in front of them, but because of poor arm and hand control they rarely contact the object. Like newborn reflexes, prereaching drops out around 7 weeks of age. Yet these early behaviors suggest that babies are biologically prepared to coordinate hand with eye in the act of exploring (Rosander & von Hofsten,  2002 ; von Hofsten,  2004 ).

At about 3 to 4 months, as infants develop the necessary eye, head, and shoulder control, reaching reappears as purposeful, forward arm movements in the presence of a nearby toy and gradually improves in accuracy (Bhat, Heathcock, & Galloway,  2005 ; Spencer et al.,  2000 ). By 5 to 6 months, infants reach for an object in a room that has been darkened during the reach by switching off the lights—a skill that improves over the next few months (Clifton et al.,  1994 ; McCarty & Ashmead,  1999 ). Early on, vision is freed from the basic act of reaching so it can focus on more complex adjustments. By 7 months, the arms become more independent; infants reach for an object by extending one arm rather than both (Fagard & Pezé,  1997 ). During the next few months, infants become more efficient at reaching for moving objects—ones that spin, change direction, and move sideways, closer, or farther away (Fagard, Spelke, & von Hofsten,  2009 ; Wentworth, Benson, & Haith,  2000 ).

Once infants can reach, they modify their grasp. The newborn’s grasp reflex is replaced by the ulnar grasp, a clumsy motion in which the fingers close against the palm. Still, even 4-month-olds adjust their grasp to the size and shape of an object—a capacity that improves over the first year as infants orient the hand more precisely and do so in advance of contacting the object (Barrett, Traupman, & Needham,  2008 ; Witherington,  2005 ). Around 4 to 5 months, when infants begin to sit up, both hands become coordinated in exploring objects. Babies of this age can hold an object in one hand while the other scans it with the fingertips, and they frequently transfer objects from hand to hand (Rochat & Goubet,  1995 ). By the end of the first year, infants use the thumb and index finger opposably in a well-coordinated pincer grasp. Then the ability to manipulate objects greatly expands. The 1-year-old can pick up raisins and blades of grass, turn knobs, and open and close small boxes.

Between 8 and 11 months, reaching and grasping are well-practiced, so attention is released from the motor skill to events that occur before and after attaining the object. For example, 10-month-olds easily adjust their reach to anticipate their next action. They reach for a ball faster when they intend to throw it than when they intend to drop it carefully through a narrow tube (Claxton, Keen, & McCarty,  2003 ). Around this time, too, infants begin to solve simple problems that involve reaching, such as searching for and finding a hidden toy.

Finally, the capacity to reach for and manipulate an object increases infants’ attention to the way an adult reaches for and plays with that same object (Hauf, Aschersleben, & Prinz,  2007 ). As babies watch what others do, they broaden their understanding of others’ behaviors and of the range of actions that can be performed on various objects.

ASK YOURSELF

REVIEW Cite evidence that motor development is a joint product of biological, psychological, and environmental factors.

CONNECT Provide several examples of how motor development influences infants’ attainment of cognitive and social competencies.

APPLY List everyday experiences that support mastery of reaching, grasping, sitting, and crawling. Why should caregivers place young infants in a variety of waking-time body positions?

REFLECT Do you favor early, systematic training of infants in motor skills such as crawling, walking, and stair climbing? Why or why not?

image9 Perceptual Development

In  Chapter 3 , you learned that the senses of touch, taste, smell, and hearing—but not vision—are remarkably well-developed at birth. Now let’s turn to a related question: How does perception change over the first year? Our discussion will address hearing and vision, the focus of almost all research. Recall that in  Chapter 3 , we used the word sensation to talk about these capacities. It suggests a fairly passive process—what the baby’s receptors detect when exposed to stimulation. Now we use the word perception, which is active: When we perceive, we organize and interpret what we see.

As we review the perceptual achievements of infancy, you may find it hard to tell where perception leaves off and thinking begins. The research we are about to discuss provides an excellent bridge to the topic of  Chapter 5 —cognitive development during the first two years.

Hearing

On Timmy’s first birthday, Vanessa bought several CDs of nursery songs, and she turned one on each afternoon at naptime. Soon Timmy let her know his favorite tune. If she put on “Twinkle, Twinkle,” he stood up in his crib and whimpered until she replaced it with “Jack and Jill.” Timmy’s behavior illustrates the greatest change in hearing over the first year of life: Babies organize sounds into increasingly elaborate patterns.

Between 4 and 7 months, infants display a sense of musical phrasing: They prefer Mozart minuets with pauses between phrases to those with awkward breaks (Krumhansl & Jusczyk,  1990 ). Around 6 to 7 months, they can distinguish musical tunes on the basis of variations in rhythmic patterns, including beat structure (duple or triple) and accent structure (emphasis on the first note of every beat unit or at other positions) (Hannon & Johnson,  2004 ). And by the end of the first year, infants recognize the same melody when it is played in different keys (Trehub,  2001 ). As we will see shortly, 6- to 12-month-olds make comparable discriminations in human speech: They readily detect sound regularities that will facilitate later language learning.

Biology and Environment “Tuning In” to Familiar Speech, Faces, and Music: A Sensitive Period for Culture-Specific Learning

To share experiences with members of their family and community, babies must become skilled at making perceptual discriminations that are meaningful in their culture. As we have seen, at first babies are sensitive to virtually all speech sounds, but around 6 months, they narrow their focus, limiting the distinctions they make to the language they hear and will soon learn.

The ability to perceive faces shows a similar  perceptual narrowing effect —perceptual sensitivity that becomes increasingly attuned with age to information most often encountered. After habituating to one member of each pair of faces in  Figure 4.12 , 6-month-olds were shown the familiar and novel faces side-by-side. For both pairs, they recovered to (looked longer at) the novel face, indicating that they could discriminate individual faces of both humans and monkeys equally well (Pascalis, de Haan, & Nelson,  2002 ). But at 9 months, infants no longer showed a novelty preference when viewing the monkey pair. Like adults, they could distinguish only the human faces. Similar findings emerge with sheep faces: 4- to 6-months-olds easily distinguish them, but 9- to 11-month olds no longer do (Simpson et al.,  2011 ).

The perceptual narrowing effect appears again in musical rhythm perception. Western adults are accustomed to the even-beat pattern of Western music—repetition of the same rhythmic structure in every measure of a tune—and easily notice rhythmic changes that disrupt this familiar beat. But present them with music that does not follow this typical Western rhythmic form—Baltic folk tunes, for example—and they fail to pick up on rhythmic-pattern deviations. Six-month-olds, however, can detect such disruptions in both Western and non-Western melodies. But by 12 months, after added exposure to Western music, babies are no longer aware of deviations in foreign musical rhythms, although their sensitivity to Western rhythmic structure remains unchanged (Hannon & Trehub,  2005b ).

Several weeks of regular interaction with a foreign-language speaker and of daily opportunities to listen to non-Western music fully restore 12-month-olds’ sensitivity to wide-ranging speech sounds and music rhythms (Hannon & Trehub,  2005a ; Kuhl, Tsao, & Liu,  2003 ). Similarly, 6-month-olds given three months of training in discriminating individual monkey faces, in which each image is labeled with a distinct name (“Carlos,” “Iona”) instead of the generic label “monkey,” retain their ability to discriminate monkey faces at 9 months (Scott & Monesson,  2009 ). Adults given similar extensive experiences, by contrast, show little improvement in perceptual sensitivity.

Taken together, these findings suggest a heightened capacity—or sensitive period—in the second half of the first year, when babies are biologically prepared to “zero in” on socially meaningful perceptual distinctions. Notice how, between 6 and 12 months, learning is especially rapid across several domains (speech, faces, and music) and is easily modified by experience. This suggests a broad neurological change—perhaps a special time of experience-expectant brain growth (see  page 127 ) in which babies analyze everyday stimulation of all kinds similarly, in ways that prepare them to participate in their cultural community.

FIGURE 4.12 Discrimination of human and monkey faces.

Which of these pairs is easiest for you to tell apart? After habituating to one of the photos in each pair, infants were shown the familiar and the novel face side-by-side. For both pairs, 6-month-olds recovered to (looked longer at) the novel face, indicating that they could discriminate human and monkey faces equally well. By 12 months, babies lost their ability to distinguish the monkey faces. Like adults, they showed a novelty preference only to human stimuli.

(From O. Pascalis et al., 2002, “Is Face Processing Species-Specific During the First Year of Life?” Science, 296, p. 1322. Copyright © 2002 by AAAS. Reprinted by permission from AAAS.)

Speech Perception.

Recall from  Chapter 3  that newborns can distinguish nearly all sounds in human languages and that they prefer listening to human speech over nonspeech sounds, and to their native tongue rather than a foreign language. As infants listen to people talking, they learn to focus on meaningful sound variations. ERP brain-wave recordings reveal that around 5 months, babies become sensitive to syllable stress patterns in their own language (Weber et al.,  2004 ). Between 6 and 8 months, they start to “screen out” sounds not used in their native tongue (Anderson, Morgan, & White,  2003 ; Polka & Werker,  1994 ). As the  Biology and Environment  box above explains, this increased responsiveness to native-language sounds is part of a general “tuning” process in the second half of the first year—a possible sensitive period in which infants acquire a range of perceptual skills for picking up socially important information.

Soon after, infants focus on larger speech segments that are critical to figuring out meaning. They recognize familiar words in spoken passages and listen longer to speech with clear clause and phrase boundaries (Johnson & Seidl,  2008 ; Jusczyk & Hohne,  1997 ; Soderstrom et al.,  2003 ). Around 7 to 9 months, infants extend this sensitivity to speech structure to individual words: They begin to divide the speech stream into wordlike units (Jusczyk,  2002 ; Saffran, Werker, & Werner,  2006 ).

Analyzing the Speech Stream.

How do infants make such rapid progress in perceiving the structure of language? Research shows that they have an impressive  statistical learning capacity . By analyzing the speech stream for patterns—repeatedly occurring sequences of sounds—they acquire a stock of speech structures for which they will later learn meanings, long before they start to talk around age 12 months.

For example, when presented with controlled sequences of nonsense syllables, babies listen for statistical regularities: They locate words by distinguishing syllables that often occur together (indicating they belong to the same word) from syllables that seldom occur together (indicating a word boundary). Consider the English word sequence pretty#baby. After listening to the speech stream for just one minute (about 60 words), 8-month-olds discriminate a word-internal syllable pair (pretty) from a word-external syllable pair (ty#ba). They prefer to listen to new speech that preserves the word-internal pattern (Saffran, Aslin, & Newport,  1996 ; Saffran & Thiessen,  2003 ).

Once infants locate words, they focus on the words and, around 7 to 8 months, identify regular syllable-stress patterns—for example, in English and Dutch, that the onset of a strong syllable (hap-py, rab-bit) often signals a new word (Swingley,  2005 ; Thiessen & Saffran,  2007 ). By 10 months, babies can detect words that start with weak syllables, such as “surprise,” by listening for sound regularities before and after the words (Jusczyk,  2001 ; Kooijman, Hagoort, & Cutler,  2009 ).

Clearly, babies have a powerful ability to extract patterns from complex, continuous speech. Some researchers believe that infants are innately equipped with a general statistical learning capacity for detecting structure in the environment, which they also apply to nonspeech auditory information and to visual stimulation. Consistent with this idea, ERP recordings suggest that newborns perceive patterns in both sequences of speech syllables and sequences of tones (Kudo et al.,  2011 ; Teinonen et al.,  2009 ). And 2-month-olds detect regularities in sequences of visual stimuli (Kirkham, Slemmer, & Johnson,  2002 ).

Vision

For exploring the environment, humans depend on vision more than any other sense. Although at first a baby’s visual world is fragmented, it undergoes extraordinary changes during the first 7 to 8 months of life.

Visual development is supported by rapid maturation of the eye and visual centers in the cerebral cortex. Recall from  Chapter 3  that the newborn baby focuses and perceives color poorly. Around 2 months, infants can focus on objects about as well as adults can, and their color vision is adultlike by 4 months (Kellman & Arterberry,  2006 ). Visual acuity (fineness of discrimination) improves steadily, reaching 20/80 by 6 months and an adult level of about 20/20 by 4 years (Slater et al.,  2010 ). Scanning the environment and tracking moving objects improve over the first half-year as infants better control their eye movements and build an organized perceptual world (Johnson, Slemmer, & Amso,  2004 ; von Hofsten & Rosander,  1998 ).

As babies explore their visual field, they figure out the characteristics of objects and how they are arranged in space. To understand how they do so, let’s examine the development of two aspects of vision: depth and pattern perception.

Depth Perception.

Depth perception is the ability to judge the distance of objects from one another and from ourselves. It is important for understanding the layout of the environment and for guiding motor activity.

Figure 4.13  shows the visual cliff, designed by Eleanor Gibson and Richard Walk ( 1960 ) and used in the earliest studies of depth perception. It consists of a Plexiglas-covered table with a platform at the center, a “shallow” side with a checkerboard pattern just under the glass, and a “deep” side with a checkerboard several feet below the glass. The researchers found that crawling babies readily crossed the shallow side, but most reacted with fear to the deep side. They concluded that around the time infants crawl, most distinguish deep from shallow surfaces and avoid drop-offs.

The visual cliff shows that crawling and avoidance of drop-offs are linked, but not how they are related or when depth perception first appears. Subsequent research has looked at babies’ ability to detect specific depth cues, using methods that do not require that they crawl.

Motion is the first depth cue to which infants are sensitive. Babies 3 to 4 weeks old blink their eyes defensively when an object moves toward their face as if it is going to hit (Nánez & Yonas,  1994 ). Binocular depth cues arise because our two eyes have slightly different views of the visual field. The brain blends these two images, resulting in perception of depth. Research in which two overlapping images are projected before the baby, who wears special goggles to ensure that each eye receives only one image, reveals that sensitivity to binocular cues emerges between 2 and 3 months and improves rapidly over the first year (Birch,  1993 ; Brown & Miracle,  2003 ). Finally, beginning at 3 to 4 months and strengthening between 5 and 7 months, babies display sensitivity to pictorial depth cues—the ones artists often use to make a painting look three-dimensional. Examples include receding lines that create the illusion of perspective, changes in texture (nearby textures are more detailed than faraway ones), overlapping objects (an object partially hidden by another object is perceived to be more distant), and shadows cast on surfaces (indicating a separation in space between the object and the surface) (Kavšek, Yonas, & Granrud,  2012 ; Shuwairi, Albert, & Johnson,  2007 ).

Why does perception of depth cues emerge in the order just described? Researchers speculate that motor development is involved. For example, control of the head during the early weeks of life may help babies notice motion and binocular cues. Around the middle of the first year, the ability to turn, poke, and feel the surface of objects promotes sensitivity to pictorial cues as infants pick up information about size, texture, and three-dimensional shape (Bushnell & Boudreau,  1993 ; Soska, Adolph, & Johnson,  2010 ). And as we will see next, one aspect of motor progress—independent movement—plays a vital role in refinement of depth perception.

FIGURE 4.13 The visual cliff.

Plexiglas covers the deep and shallow sides. By refusing to cross the deep side and showing a preference for the shallow side, this infant demonstrates the ability to perceive depth.

Independent Movement and Depth Perception.

At 6 months, Timmy started crawling. “He’s fearless!” exclaimed Vanessa. “If I put him down in the middle of my bed, he crawls right over the edge. The same thing happens by the stairs.” Will Timmy become wary of the side of the bed and the staircase as he becomes a more experienced crawler? Research suggests that he will. Infants with more crawling experience (regardless of when they started to crawl) are far more likely to refuse to cross the deep side of the visual cliff (Campos et al.,  2000 ).

From extensive everyday experience, babies gradually figure out how to use depth cues to detect the danger of falling. But because the loss of body control that leads to falling differs greatly for each body position, babies must undergo this learning separately for each posture. In one study, 9-month-olds who were experienced sitters but novice crawlers were placed on the edge of a shallow drop-off that could be widened (Adolph,  2002 ,  2008 ). While in the familiar sitting position, infants avoided leaning out for an attractive toy at distances likely to result in falling. But in the unfamiliar crawling posture, they headed over the edge, even when the distance was extremely wide! And newly walking babies, while avoiding sharp drop-offs, careen down slopes and over uneven surfaces without making the necessary postural adjustments, even when their mothers discourage them from proceeding! Thus, they fall frequently (Adolph et al.,  2008 ; Joh & Adolph,  2006 ). As infants discover how to avoid falling in different postures and situations, their understanding of depth expands.

Crawling experience promotes other aspects of three-dimensional understanding. For example, seasoned crawlers are better than their inexperienced agemates at remembering object locations and finding hidden objects (Bai & Bertenthal,  1992 ; Campos et al.,  2000 ). Why does crawling make such a difference?

Infants must learn to use depth cues to avoid falling in each new position—sitting, crawling, walking—and in various situations. As this 10-month-old takes her first steps, she uses vision to make postural adjustments, and her understanding of depth expands.

TAKE A MOMENT…  Compare your own experience of the environment when you are driven from one place to another with what you experience when you walk or drive yourself. When you move on your own, you are much more aware of landmarks and routes of travel, and you take more careful note of what things look like from different points of view. The same is true for infants. In fact, crawling promotes a new level of brain organization, as indicated by more organized EEG brain-wave activity in the cerebral cortex (Bell & Fox,  1996 ). Perhaps crawling strengthens certain neural connections, especially those involved in vision and understanding of space.

Pattern Perception.

Even newborns prefer to look at patterned rather than plain stimuli (Fantz,  1961 ). As they get older, infants prefer more complex patterns. For example, 3-week-old infants look longest at black-and-white checkerboards with a few large squares, whereas 8- and 14-week-olds prefer those with many squares (Brennan, Ames, & Moore,  1966 ).

A general principle, called  contrast sensitivity , explains early pattern preferences (Banks & Ginsburg, 1985 ). Contrast refers to the difference in the amount of light between adjacent regions in a pattern. If babies are sensitive to (can detect) the contrast in two or more patterns, they prefer the one with more contrast. To understand this idea, look at the checkerboards in the top row of  Figure 4.14 . To us, the one with many small squares has more contrasting elements. Now look at the bottom row, which shows how these checkerboards appear to infants in the first few weeks of life. Because of their poor vision, very young babies cannot resolve the small features in more complex patterns, so they prefer to look at the large, bold checkerboard. Around 2 months, when detection of fine-grained detail has improved, infants become sensitive to the contrast in complex patterns and spend more time looking at them (Gwiazda & Birch,  2001 ). Contrast sensitivity continues to increase during infancy and childhood.

In the early weeks of life, infants respond to the separate parts of a pattern. They stare at single, high-contrast features and have difficulty shifting their gaze away toward other interesting stimuli (Hunnius & Geuze,  2004a ,  2004b ). At 2 to 3 months, when scanning ability and contrast sensitivity improve, infants thoroughly explore a pattern’s features, pausing briefly to look at each part (Bronson,  1994 ).

Once babies take in all aspects of a pattern, they integrate the parts into a unified whole. Around 4 months, babies are so good at detecting pattern organization that they perceive subjective boundaries that are not really present. For example, they perceive a square in the center of  Figure 4.15a , just as you do (Ghim,  1990 ). Older infants carry this sensitivity to subjective form further, applying it to complex, moving stimuli. For example, 9-month-olds look much longer at an organized series of blinking lights that resembles a human being walking than at an upside-down or scrambled version (Bertenthal,  1993 ). At 12 months, infants detect familiar objects represented by incomplete drawings, even when as much as two-thirds of the drawing is missing (see  Figure 4.15b ) (Rose, Jankowski, & Senior,  1997 ). As these findings reveal, infants’ increasing knowledge of objects and actions supports pattern perception.

FIGURE 4.14 The way two checkerboards differing in complexity look to infants in the first few weeks of life.

Because of their poor vision, very young infants cannot resolve the fine detail in the complex checkerboard. It appears blurred, like a gray field. The large, bold checkerboard appears to have more contrast, so babies prefer to look at it.

(Adapted from M. S. Banks & P. Salapatek, 1983, “Infant Visual Perception,” in M. M. Haith & J. J. Campos [Eds.], Handbook of Child Psychology: Vol. 2. Infancy and Developmental Psychobiology [4th ed.], p. 504. Copyright © 1983 by John Wiley & Sons, Inc. Reproduced with permission of John Wiley & Sons, Inc.)

FIGURE 4.15 Subjective boundaries in visual patterns.

(a) Do you perceive a square in the middle of the figure? By 4 months of age, infants do, too. (b) What does the image, missing two-thirds of its outline, look like to you? By 12 months, infants detect a motorcycle. After habituating to the incomplete motorcycle image, they were shown an intact motorcycle figure paired with a novel form. Twelve-month-olds recovered to (looked longer at) the novel figure, indicating that they recognized the motorcycle pattern on the basis of very little visual information.

(Adapted from Ghim, 1990; Rose, Jankowski, & Senior, 1997.)

FIGURE 4.16 Early face perception.

Newborns prefer to look at the photo of a face (a) and the simple pattern resembling a face (b) over the upside-down versions. (c) When the complex drawing of a face on the left and the equally complex, scrambled version on the right are moved across newborns’ visual field, they follow the face longer. But if the two stimuli are stationary, infants show no preference for the face until around 2 months of age.

(From Cassia, Turati, & Simion, 2004; Johnson, 1999; Mondloch et al., 1999.)

Face Perception.

Infants’ tendency to search for structure in a patterned stimulus also applies to face perception. Newborns prefer to look at photos and simplified drawings of faces with features arranged naturally (upright) rather than unnaturally (upside-down or sideways) (see  Figure 4.16a ) (Cassia, Turati, & Simion,  2004 ; Mondloch et al.,  1999 ). They also track a facelike pattern moving across their visual field farther than they track other stimuli (Johnson,  1999 ). And although they rely more on high-contrast, outer features (hairline and chin) than inner features to distinguish real faces, newborns prefer photos of faces with eyes open and a direct gaze (Farroni et al.,  2002 ; Turati et al.,  2006 ). Yet another amazing capacity is their tendency to look longer at both human and animal faces judged by adults as attractive—a preference that may be the origin of the widespread social bias favoring physically attractive people (Quinn et al.,  2008 ; Slater et al.,  2010 ).

Some researchers claim that these behaviors reflect a built-in capacity to orient toward members of one’s own species, just as many newborn animals do (Johnson,  2001 ; Slater et al.,  2011 ). Others assert that newborns prefer any stimulus in which the most salient elements are arranged horizontally in the upper part of a pattern—like the “eyes” in  Figure 4.16b  (Turati,  2004 ). Possibly, however, a bias favoring the facial pattern promotes such preferences. Still other researchers argue that newborns are exposed to faces more often than to other stimuli—early experiences that could quickly “wire” the brain to detect faces and prefer attractive ones (Nelson,  2001 ).

Although newborns respond to facelike structures, they cannot discriminate a complex facial pattern from other, equally complex patterns (see  Figure 4.16c ). But from repeated exposures to their mother’s face, they quickly learn to prefer her face to that of an unfamiliar woman, although they mostly attend to its broad outlines. Around 2 months, when they can combine pattern elements into an organized whole, babies prefer a complex drawing of the human face to other equally complex stimulus arrangements (Dannemiller & Stephens,  1988 ). And they clearly prefer their mother’s detailed facial features to those of another woman (Bartrip, Morton, & de Schonen,  2001 ).

Around 3 months, infants make fine distinctions among the features of different faces—for example, between photographs of two strangers, even when the faces are moderately similar (Farroni et al.,  2007 ). At 5 months—and strengthening over the second half-year—infants perceive emotional expressions as meaningful wholes. They treat positive faces (happy and surprised) as different from negative ones (sad and fearful) (Bornstein & Arterberry,  2003 ; Ludemann,  1991 ).

Experience influences face processing, leading babies to form group biases at a tender age. As early as 3 months, infants prefer and more easily discriminate among female faces than among male faces (Quinn et al.,  2002 ; Ramsey-Rennels & Langlois,  2006 ). The greater time infants spend with female adults explains this effect, since babies with a male primary caregiver prefer male faces. Furthermore, 3- to 6-month-olds exposed mostly to members of their own race prefer to look at the faces of members of that race and more easily detect differences among those faces (Bar-Haim et al.,  2006 ; Kelly et al.,  2007 ,  2009 ). This own-race face preference is absent in babies who have frequent contact with members of other races, and it can be reversed through exposure to racial diversity (Sangrigoli et al.,  2005 ).  TAKE A MOMENT…  Notice how early experience promotes perceptual narrowing with respect to gender and racial information in faces, as occurs for species information, discussed in the  Biology and Environment  box on  page 141 .

Clearly, extensive face-to-face interaction with caregivers contributes to infants’ refinement of face perception. And as babies recognize and respond to the expressive behavior of others, face perception supports their earliest social relationships.

Up to this point, we have considered the infant’s sensory systems one by one. Now let’s examine their coordination.

Intermodal Perception

Our world provides rich, continuous intermodal stimulation—simultaneous input from more than one modality, or sensory system. In  intermodal perception , we make sense of these running streams of light, sound, tactile, odor, and taste information, perceiving them as integrated wholes. We know, for example,that an object’s shape is the same whether we see it or touch it, that lip movements are closely coordinated with the sound of a voice, and that dropping a rigid object on a hard surface will cause a sharp, banging sound.

This baby exploring the surface of a guitar readily picks up amodal information, such as common rate, rhythm, duration, and temporal synchrony, in the visual appearance and sounds of its moving strings.

Recall that newborns turn in the general direction of a sound and reach for objects in a primitive way. These behaviors suggest that infants expect sight, sound, and touch to go together. Research reveals that babies perceive input from different sensory systems in a unified way by detecting amodal sensory properties—information that overlaps two or more sensory systems, such as rate, rhythm, duration, intensity, temporal synchrony (for vision and hearing), and texture and shape (for vision and touch). Consider the sight and sound of a bouncing ball or the face and voice of a speaking person. In each event, visual and auditory information occur simultaneously and with the same rate, rhythm, duration, and intensity.

Even newborns are impressive perceivers of amodal properties. After touching an object (such as a cylinder) placed in their palms, they recognize it visually, distinguishing it from a different-shaped object (Sann & Streri,  2007 ). And they require just one exposure to learn the association between the sight and sound of a toy, such as a rhythmically jangling rattle (Morrongiello, Fenwick, & Chance,  1998 ).

Within the first half-year, infants master a remarkable range of intermodal relationships. Three- to 4-month-olds can match faces with voices on the basis of lip–voice synchrony, emotional expression, and even age and gender of the speaker (Bahrick, Netto, & Hernandez-Reif,  1998 ). Between 4 and 6 months, infants can perceive and remember the unique face–voice pairings of unfamiliar adults (Bahrick, Hernandez-Reif, & Flom,  2005 ).

How does intermodal perception develop so quickly? Young infants seem biologically primed to focus on amodal information. Their detection of amodal relations—for example, the common tempo and rhythm in sights and sounds—precedes and seems to provide the basis for detecting more specific intermodal matches, such as the relation between a particular person’s face and the sound of her voice or between an object and its verbal label (Bahrick, Hernandez-Reif, & Flom,  2005 ).

Intermodal sensitivity is crucial for perceptual development. In the first few months, when much stimulation is unfamiliar and confusing, it enables babies to notice meaningful correlations between sensory inputs and rapidly make sense of their surroundings (Bahrick, Lickliter, & Flom,  2004 ).

In addition to easing perception of the physical world, intermodal perception facilitates social and language processing. For example, as 3- to 4-month-olds gaze at an adult’s face, they initially require both vocal and visual input to distinguish positive from negative emotional expressions (Walker-Andrews,  1997 ). Only later do infants discriminate positive from negative emotion in each sensory modality—first in voices (around 4 to 5 months), later (from 5 months on) in faces (Bahrick, Hernandez-Reif, & Flom,  2005 ). Furthermore, in speaking to infants, parents often provide temporal synchrony between words, object motions, and touch—for example, saying “doll” while moving a doll and having it touch the infant. This greatly increases the chances that babies will remember the association between the word and the object (Gogate & Bahrick,  1998 ,  2001 ).

LOOK AND LISTEN

While watching a parent and infant playing, list instances of parental intermodal stimulation and communication. What is the baby likely learning about people, objects, or language from each intermodal experience?

In sum, intermodal perception fosters all aspects of psychological development. When caregivers provide many concurrent sights, sounds, and touches, babies process more information and learn faster (Bahrick,  2010 ). Intermodal perception is yet another fundamental capacity that assists infants in their active efforts to build an orderly, predictable world.

Understanding Perceptual Development

Now that we have reviewed the development of infant perceptual capacities, how can we put together this diverse array of amazing achievements? Widely accepted answers come from the work of Eleanor and James Gibson. According to the Gibsons’  differentiation theory , infants actively search for invariant features of the environment—those that remain stable—in a constantly changing perceptual world. In pattern perception, for example, young babies search for features that stand out and orient toward faces. Soon they thoroughly explore a stimulus, noticing stable relationships among its features. As a result, they detect patterns, such as complex designs and individual faces. Similarly, infants analyze the speech stream for regularities, detecting words, word-order sequences, and—within words—syllable-stress patterns. The development of intermodal perception also reflects this principle. Babies seek out invariant relationships—first, amodal properties, such as common rate and rhythm, in a voice and face, and later, more detailed associations, such as unique voice–face matches.

FIGURE 4.17 Acting on the environment plays a major role in perceptual differentiation.

Crawling and walking change the way babies perceive a sloping surface. The newly crawling infant on the left plunges headlong down the slope. He has not yet learned that it affords the possibility of falling. The toddler on the right, who has been walking for more than a month, approaches the slope cautiously. Experience in trying to remain upright but frequently tumbling over has made him more aware of the consequences of his movements. He perceives the incline differently than he did at a younger age.

The Gibsons described their theory as differentiation (where differentiate means “analyze” or “break down”) because over time, the baby detects finer and finer invariant features among stimuli. In addition to pattern perception and intermodal perception, differentiation applies to depth perception. Recall how sensitivity to motion precedes detection of fine-grained pictorial features. So one way of understanding perceptual development is to think of it as a built-in tendency to seek order and consistency—a capacity that becomes increasingly fine-tuned with age (Gibson,  1970 ; Gibson,  1979 ).

Infants constantly look for ways in which the environment affords possibilities for action (Gibson,  2000 ,  2003 ). By exploring their surroundings, they figure out which things can be grasped, squeezed, bounced, or stroked and whether a surface is safe to cross or presents the possibility of falling (Adolph & Eppler,  1998 ,  1999 ). And from handling objects, babies become more aware of a variety of observable object properties (Perone et al.,  2008 ). As a result, they differentiate the world in new ways and act more competently.

To illustrate, recall how infants’ changing capabilities for independent movement affect their perception. When babies crawl, and again when they walk, they gradually realize that a sloping surface affords the possibility of falling (see  Figure 4.17 ). With added weeks of practicing each skill, they hesitate to crawl or walk down a risky incline. Experience in trying to keep their balance on various surfaces makes crawlers and walkers more aware of the consequences of their movements. Crawlers come to detect when surface slant places so much body weight on their arms that they will fall forward, and walkers come to sense when an incline shifts body weight so their legs and feet can no longer hold them upright. Learning is gradual and effortful because newly crawling and walking babies cross many types of surfaces in their homes each day (Adolph,  2008 ; Adolph & Joh,  2009 ). As they experiment with balance and postural adjustments to accommodate each, they perceive surfaces in new ways that guide their movements. As a result, they act more competently.

As we conclude our discussion of infant perception, it is only fair to note that some researchers believe that babies do more than make sense of experience by searching for invariant features and action possibilities: They also impose meaning on what they perceive, constructing categories of objects and events in the surrounding environment. We have seen the glimmerings of this cognitive point of view in this chapter. For example, older babies interpret a familiar face as a source of pleasure and affection and a pattern of blinking lights as a moving human being. This cognitive perspective also has merit in understanding the achievements of infancy. In fact, many researchers combine these two positions, regarding infant development as proceeding from a perceptual to a cognitive emphasis over the first year of life.

ASK YOURSELF

REVIEW Using examples, explain why intermodal perception is vital for infants’ developing understanding of their physical and social worlds.

CONNECT According to differentiation theory, perceptual development reflects infants’ active search for invariant features. Provide examples from research on hearing, pattern perception, and intermodal perception.

APPLY After several weeks of crawling, Ben learned to avoid going headfirst down a steep incline. Now he has started to walk. Can his parents trust him not to try walking down a steep surface? Explain.

SUMMARY

Body Growth ( p. 120 )

Describe major changes in body growth over the first two years.

· ● Height and weight gains are greater during the first two years than at any other time after birth. Body fat is laid down quickly during the first nine months, whereas muscle development is slow and gradual. Body proportions change as growth follows the cephalocaudal and proximodistal trends.

Brain Development ( p. 121 )

· Describe brain development during infancy and toddlerhood, including appropriate stimulation to support the brain’s potential.

· ● Early in development, the brain grows faster than any other organ of the body. Once neurons are in place, they rapidly form synapses. To communicate, neurons release chemicals called neurotransmitters, which cross synapses. Programmed cell death makes space for neural fibers and synapses. Neurons that are seldom stimulated lose their synapses in a process called synaptic pruning. Glial cells, responsible for myelination, multiply rapidly through the second year, contributing to large gains in brain weight.

· ● The cerebral cortex is the largest, most complex brain structure and the last to stop growing. Its frontal lobes, which contain the prefrontal cortex, have the most extended period of development. Gradually, the hemispheres of the cerebral cortex specialize, a process called lateralization. But in the first few years of life, there is high brain plasticity, with many areas not yet committed to specific functions.

· ● Both heredity and early experience contribute to brain organization. Stimulation of the brain is essential during sensitive periods, when the brain is developing most rapidly. Prolonged early deprivation can impair functioning of the cerebral cortex, especially the prefrontal cortex, and interfere with the brain’s capacity to manage stress, with long-term physical and psychological consequences.

· ● Appropriate early stimulation promotes experience-expectant brain growth, which depends on ordinary experiences. No evidence exists for a sensitive period in the first few years for experience-dependent brain growth, which relies on specific learning experiences. In fact, environments that overwhelm children with inappropriately advanced expectations can undermine the brain’s potential.

How does the organization of sleep and wakefulness change over the first two years?

· ● Infants’ changing arousal patterns are primarily affected by brain growth, but the social environment also plays a role. Periods of sleep and wakefulness become fewer but longer, increasingly conforming to a night–day schedule. Parents in Western nations try to get their babies to sleep through the night much earlier than parents throughout most of the world, who are more likely to sleep with their babies.

Influences on Early Physical Growth ( p. 130 )

Cite evidence that heredity and nutrition both contribute to early physical growth.

· ● Twin and adoption studies reveal that heredity contributes to body size and rate of physical growth.

· ● Breast milk is ideally suited to infants’ growth needs. Breastfeeding protects against disease and prevents malnutrition and infant death in poverty-stricken areas of the world.

· ● Most infants and toddlers can eat nutritious foods freely without risk of becoming overweight. However, because of unhealthy parental feeding practices, the relationship between rapid weight gain in infancy and later obesity is strengthening.

· ● Marasmus and kwashiorkor, two dietary diseases caused by malnutrition, affect many children in developing countries. If prolonged, they can permanently stunt body growth and brain development.

Learning Capacities ( p. 133 )

· Describe infant learning capacities, the conditions under which they occur, and the unique value of each.

· ● Classical conditioning is based on the infant’s ability to associate events that usually occur together in the everyday world. Infants can be classically conditioned most easily when the pairing of an unconditioned stimulus (UCS) and a conditioned stimulus (CS) has survival value.

· ● In operant conditioning, infants act on the environment, and their behavior is followed by either reinforcers, which increase the occurrence of a preceding behavior, or punishment, which either removes a desirable stimulus or presents an unpleasant one to decrease the occurrence of a response. In young infants, interesting sights and sounds and pleasurable caregiver interaction serve as effective reinforcers.

· ● Habituation and recovery reveal that at birth, babies are attracted to novelty. Novelty preference (recovery to a novel stimulus) assesses recent memory, whereas familiarity preference (recovery to the familiar stimulus) assesses remote memory.

· ● Newborns have a primitive ability to imitate adults’ facial expressions and gestures. Imitation is a powerful means of learning, which contributes to the parent–infant bond. Specialized cells called mirror neurons underlie infants’ capacity to imitate, but whether imitation is a voluntary capacity in newborns remains controversial.

Motor Development ( p. 136 )

Describe dynamic systems theory of motor development, along with factors that influence motor progress in the first two years.

· ● According to dynamic systems theory of motor development, children acquire new motor skills by combining existing skills into increasingly complex systems of action. Each new skill is a joint product of central nervous system development, the body’s movement possibilities, the child’s goals, and environmental supports for the skill.

· ● Movement opportunities and a stimulating environment contribute to motor development, as shown by observations of infants learning to crawl and walk in varying contexts. Cultural values and child-rearing customs also contribute to the emergence and refinement of motor skills.

· ● During the first year, infants perfect reaching and grasping. Reaching gradually becomes more accurate and flexible, and the clumsy ulnar grasp is transformed into a refined pincer grasp.

Perceptual Development ( p. 140 )

· What changes in hearing, depth and pattern perception, and intermodal perception take place during infancy?

· ● Infants organize sounds into increasingly complex patterns and, as part of the perceptual narrowing effect, begin to “screen out” sounds not used in their native tongue by the middle of the first year. An impressive statistical learning capacity enables babies to detect regular sound patterns, for which they will later learn meanings.

· ● Rapid maturation of the eye and visual centers in the brain supports the development of focusing, color discrimination, and visual acuity during the first half-year. The ability to scan the environment and track moving objects also improves.

· ● Research on depth perception reveals that responsiveness to motion cues develops first, followed by sensitivity to binocular and then to pictorial cues. Experience in crawling enhances depth perception and other aspects of three-dimensional understanding, but babies must learn to avoid drop-offs for each body position.

· ● Contrast sensitivity explains infants’ early pattern preferences. At first, babies stare at single, high-contrast features. At 2 to 3 months, they thoroughly explore a pattern’s features and start to detect pattern organization. Over time, they discriminate increasingly complex, meaningful patterns.

· ● Newborns prefer to look at and track simple, facelike stimuli, but researchers disagree on whether they have a built-in tendency to orient toward human faces. Around 2 months, they recognize and prefer their mother’s facial features, and at 3 months, they distinguish the features of different faces. Starting at 5 months, they perceive emotional expressions as meaningful wholes.

· ● From the start, infants are capable of intermodal perception—combining information across sensory modalities. Detection of amodal relations (such as common tempo or rhythm) may provide the basis for detecting other intermodal matches.

Explain differentiation theory of perceptual development.

· ● According to differentiation theory, perceptual development is a matter of detecting invariant features in a constantly changing perceptual world. Acting on the world plays a major role in perceptual differentiation. From a more cognitive perspective, infants also impose meaning on what they perceive. Many researchers combine these two ideas.

Important Terms and Concepts

brain plasticity ( p. 124 )

cephalocaudal trend ( p. 121 )

cerebral cortex ( p. 124 )

classical conditioning ( p. 133 )

conditioned response (CR) ( p. 134 )

conditioned stimulus (CS) ( p. 134 )

contrast sensitivity ( p. 144 )

differentiation theory ( p. 146 )

dynamic systems theory of motor development ( p. 137 )

experience-dependent brain growth ( p. 128 )

experience-expectant brain growth ( p. 127 )

glial cells ( p. 122 )

habituation ( p. 134 )

imitation ( p. 135 )

intermodal perception ( p. 145 )

kwashiorkor ( p. 132 )

lateralization ( p. 124 )

marasmus ( p. 132 )

mirror neurons ( p. 136 )

myelination ( p. 122 )

neurons ( p. 121 )

neurotransmitters ( p. 121 )

operant conditioning ( p. 134 )

perceptual narrowing effect ( p. 141 )

prefrontal cortex ( p. 124 )

programmed cell death ( p. 122 )

proximodistal trend ( p. 121 )

punishment ( p. 134 )

recovery ( p. 134 )

reinforcer ( p. 134 )

statistical learning capacity ( p. 142 )

synapses ( p. 121 )

synaptic pruning ( p. 122 )

unconditioned response (UCR) ( p. 133 )

unconditioned stimulus (UCS) ( p. 133 )

 
Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

Decoding The Ethics Code, Ch. 6 assignmassignment help

Decoding The Ethics Code, Ch. 6 assignmassignment help

CHAPTER 6

Standards on

Human Relations

3. Human Relations

3.01 Unfair Discrimination

In their work-related activities, psychologists do not engage in unfair discrimination based on age,

gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability,

socioeconomic status, or any basis proscribed by law.

Psychologists respect the dignity and worth of all people and appropriately consider

the relevance of personal characteristics based on factors such as age, gender,

gender identity, race, ethnicity, culture, national origin, religion, sexual orientation,

disability, or socioeconomic status (Principle E: Respect for People’s Rights and

Dignity). Much of the work of psychologists entails making valid discriminating

judgments that best serve the people and organizations they work with and fulfilling

their ethical obligations as teachers, researchers, organizational consultants, and

practitioners. Standard 3.01 of the APA Ethics Code (APA, 2002b) does not prohibit

such discriminations.

􀀵 The graduate psychology faculty of a university used differences in standardized test

scores, undergraduate grades, and professionally related experience as selection criteria

for program admission.

􀀵 A research psychologist sampled individuals from specific age, gender, and cultural

groups to test a specific hypothesis relevant to these groups.

􀀵 An organizational psychologist working for a software company designed assessments

for employee screening and promotion to distinguish individuals with the

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

92——PART II ENFORCEABLE STANDARDS

Standard 3.01 does not require psychologists offering therapeutic assistance to

accept as clients/patients all individuals who request mental health services. Discerning

and prudent psychologists know the limitations of their competence and accept to

treat only those whom they can reasonably expect to help based on their education,

training, and experience (Striefel, 2007). Psychologists may also refuse to accept

clients/patients on the basis of individuals’ lack of commitment to the therapeutic

process, problems they have that fall outside the therapists’ area of competence, or their

perceived inability or unwillingness to pay for services (Knapp & VandeCreek, 2003).

Psychologists must, however, exercise reasonable judgment and precautions to

ensure that their work does not reflect personal or organizational biases or prejudices

that can lead to injustice (Principle D: Justice). For example, the American

Psychological Association’s (APA’s) Resolution on Religious, Religion-Based, and/or

Religion-Derived Prejudice (APA, 2007d) condemns prejudice and discrimination

against individuals or groups based on their religious or spiritual beliefs, practices,

adherence, or background.

Standard 3.01 prohibits psychologists from making unfair discriminations based

on the factors listed in the standard.

requisite information technology skills to perform tasks essential to the positions from

individuals not possessing these skills.

􀀵 A school psychologist considers factors such as age, English language proficiency, and

hearing or vision impairment when making educational placement recommendations.

􀀵 A family bereavement counselor working in an elder care unit of a hospital regularly

considered the extent to which factors associated with the families’ culture or religious

values should be considered in the treatment plan.

􀀵 A psychologist conducting couples therapy with gay partners worked with clients to

explore the potential effects of homophobia, relational ambiguity, and family support

on their relationship (Green & Mitchell, 2002).

􀀴 The director of a graduate program in psychology rejected a candidate for program

admission because the candidate indicated that he was a Muslim.

􀀴 A consulting psychologist agreed to a company’s request to develop pre-employment

procedures that would screen out applicants from Spanish-speaking cultures based on

the company’s presumption that the majority of such candidates would be undocumented

residents.

􀀴 A psychologist working in a Medicaid clinic decided not to include a cognitive component

in a behavioral treatment based solely on the psychologist’s belief that lowerincome

patients were incapable of responding to “talk therapies.”

􀀴 One partner of a gay couple who recently entered couple counseling called their psychologist

when he learned that he tested positive for the HIV virus. Although when

working with heterosexual couples the psychologist strongly encouraged clients to

inform their partners if they had a sexually transmitted disease, she did not believe such

an approach was necessary in this situation based on her erroneous assumption that

all gay men engaged in reckless and risky sexual behavior (see Palma & Iannelli, 2002).

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

Chapter 6 Standards on Human Relations——93

Discrimination Proscribed by Law

Standard 3.01 prohibits psychologists from discriminating among individuals on

any basis proscribed by law. For example, industrial–organizational psychologists

need to be aware of nondiscrimination laws relevant to race, religion, and disability

that apply to companies for which they work (e.g., ADA, www.ada.gov; Title VII of

the Civil Rights Act of 1964, www.eeoc.gov/laws/statutes/titlevii.cfm, archive.eeoc

.gov/types/religion.html; Workforce Investment Act of 1998, www.doleta.gov/

usworkforce/wia/wialaw.txt). Psychologists conducting personnel performance

evaluations should avoid selecting tests developed to assess psychopathology (see

Karraker v. Rent-a-Center, 2005). In addition, under ADA (1990), disability-relevant

questions can only be asked of prospective employees after the employer has made

a conditional offer. In some instances, ADA laws for small businesses also apply to

psychologists in private practice, such as wheelchair accessibility. In addition,

HIPAA prohibits covered entities from discriminating against an individual for filing

a complaint, participating in a compliance review or hearing, or opposing an act or

practice that is unlawful under the regulation (45 CFR 164.530[g]).

3.02 Sexual Harassment

Psychologists do not engage in sexual harassment. Sexual harassment is sexual solicitation,

physical advances, or verbal or nonverbal conduct that is sexual in nature, that occurs in connection

with the psychologist’s activities or role as a psychologist, and that either (1) is unwelcome,

is offensive, or creates a hostile workplace or educational environment, and the psychologist

knows or is told this; or (2) is sufficiently severe or intense to be abusive to a reasonable person

in the context. Sexual harassment can consist of a single intense or severe act or of multiple

persistent or pervasive acts. (See also Standard 1.08, Unfair Discrimination Against Complainants

and Respondents.)

It is always wise for psychologists to be familiar with and comply with applicable

laws and institutional policies regarding sexual harassment. Laws on sexual

harassment vary across jurisdictions, are often complex, and change over time.

Standard 3.02 provides a clear definition of behaviors that are prohibited and considered

sexual harassment under the Ethics Code. When this definition establishes

a higher standard of conduct than required by law, psychologists must comply

with Standard 3.02.

According to Standard 3.02, sexual harassment can be verbal or nonverbal

solicitation, advances, or sexual conduct that occurs in connection with the psychologist’s

activities or role as a psychologist. The wording of the definition was

carefully crafted to prohibit sexual harassment without encouraging complaints

against psychologists whose poor judgments or behaviors do not rise to the level of

harassment. Thus, to meet the standard’s threshold for sexual harassment, behaviors

have to be either so severe or intense that a reasonable person would deem

them abusive in that context, or, regardless of intensity, the psychologist was aware

or had been told that the behaviors are unwelcome, offensive, or creating a hostile

workplace or educational environment.

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

94——PART II ENFORCEABLE STANDARDS

For example, a senior faculty member who places an arm around a student’s

shoulder during a discussion or who tells an off-color sexual joke that offends a

number of junior faculty may not be in violation of this standard if such behavior

is uncharacteristic of the faculty member’s usual conduct, if a reasonable

person might interpret the behavior as inoffensive, and if there is reason to

assume the psychologist neither is aware of nor has been told the behavior is

offensive.

A hostile workplace or educational environment is one in which the sexual

language or behaviors of the psychologist impairs the ability of those who are the

target of the sexual harassment to conduct their work or participate in classroom

and educational experiences. The actions of the senior faculty member described

above might be considered sexual harassment if the psychologist’s behaviors

reflected a consistent pattern of sexual conduct during class or office hours, if

such behaviors had led students to withdraw from the psychologist’s class, or if

students or other faculty had repeatedly told the psychologist about the discomfort

produced.

􀀴 A senior psychologist at a test company sexually fondled a junior colleague during an

office party.

􀀴 During clinical supervision, a trainee had an emotional discussion with her female

supervisor about how her own experiences recognizing her lesbian sexual orientation

during adolescence were helping her counsel the gay and lesbian youths

she was working with. At the end of the session, the supervisor kissed the trainee

on the lips.

According to this standard, sexual harassment can also consist of a single intense

or severe act that would be considered abusive to a reasonable person.

A violation of this standard applies to all psychologists irrespective of the status,

sex, or sexual orientation of the psychologist or individual harassed.

3.03 Other Harassment

Psychologists do not knowingly engage in behavior that is harassing or demeaning to persons

with whom they interact in their work based on factors such as those persons’ age, gender, gender

identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language,

or socioeconomic status.

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

Chapter 6 Standards on Human Relations——95

According to Principle E: Respect for People’s Rights and Dignity, psychologists

should eliminate from their work the effect of bias and prejudice based on factors

such as age, gender, gender identity, race, ethnicity, national origin, religion, sexual

orientation, disability, language, and socioeconomic status. Standard 3.03 prohibits

behaviors that draw on these categories to harass or demean individuals with

whom psychologists work, such as colleagues, students, research participants, or

employees. Behaviors in violation of this standard include ethnic slurs and negative

generalizations based on gender, sexual orientation, disability, or socioeconomic

status whose intention or outcome is lowering status or reputation.

The term knowingly reflects the fact that evolving societal sensitivity to language

and behaviors demeaning to different groups may result in psychologists unknowingly

acting in a pejorative manner. The term knowingly also reflects awareness that

interpretations of behaviors that are harassing or demeaning can often be subjective.

Thus, a violation of this standard rests on an objective evaluation that a psychologist

would have or should have been aware that his or her behavior would be

perceived as harassing or demeaning.

This standard does not prohibit psychologists from critical comments about

the work of students, colleagues, or others based on legitimate criteria. For

example, professors can inform, and often have a duty to inform, students that

their writing or clinical skills are below program standards or indicate when a

student’s classroom comment is incorrect or inappropriate. It is the responsibility

of employers or chairs of academic departments to critically review, report on,

and discuss both positive and negative evaluations of employees or faculty.

Similarly, the standard does not prohibit psychologists conducting assessment or

therapy from applying valid diagnostic classifications that a client/patient may

find offensive.

3.04 Avoiding Harm

Psychologists take reasonable steps to avoid harming their clients/patients, students, supervisees,

research participants, organizational clients, and others with whom they work, and to minimize

harm where it is foreseeable and unavoidable.

As articulated in Principle A: Beneficence and Nonmaleficence, psychologists

seek to safeguard the welfare of those with whom they work and avoid or minimize

harm when conflicts occur among professional obligations. In the rightly practiced

profession and science of psychology, harm is not always unethical or avoidable.

Legitimate activities that may lead to harm include (a) giving low grades to students

who perform poorly on exams; (b) providing a valid diagnosis that prevents a

client/patient from receiving disability insurance; (c) conducting personnel reviews

that lead to an individual’s termination of employment; (d) conducting a custody

evaluation in a case in which the judge determines one of the parents must relinquish

custodial rights; or (e) disclosing confidential information to protect the

physical welfare of a third party.

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

96——PART II ENFORCEABLE STANDARDS

Steps for Avoiding Harm

Recognizing that such harms are not always avoidable or inappropriate,

Standard 3.04 requires psychologists to take reasonable steps to avoid harming

those with whom they interact in their professional and scientific roles and to

minimize harm where it is foreseeable and unavoidable.

These steps often include complying with other standards in the Ethics Code,

such as the following:

􀀵 Parents of a fourth-grade student wanted their child placed in a special education

class. After administering a complete battery of tests, the school psychologist’s

report indicated that the child’s responses did not meet established definitions for

learning disabilities and therefore did not meet the district’s criteria for such

placement.

􀀵 A forensic psychologist was asked to evaluate the mental status of a criminal

defendant who was asserting volitional insanity as a defense against liability in

his trial for manslaughter. The psychologist conducted a thorough evaluation

based on definitions of volitional insanity and irresistible impulse established by

the profession of psychology and by law. While the psychologist’s report noted

that the inmate had some problems with impulse control and emotional instability,

it also noted that these deficiencies did not meet the legal definition of volitional

that would bar prosecution (see also Hot Topic “Human Rights and

Psychologists’ Involvement in Assessments Related to Death Penalty Cases” in

Chapter 4).

􀀴 A psychologist conducted therapy over the Internet for clients/patients in a rural area

120 miles from her office. The psychologist had not developed a plan with each client/

patient for handling mental health crises. During a live video Internet session, a client

who had been struggling with bouts of depression showed the psychologist his gun

and said he was going outside to “blow his head off.” The psychologist did not have

the contact information of any local hospital, relative, or friend to send prompt emergency

assistance.

􀀴 A psychologist with prescription privileges prescribed a Food and Drug Administration

(FDA)-approved neuroenhancer to help a young adult patient suffering from performance

anxiety associated with his responsibilities as quarterback for his college varsity

football team. The psychologist failed to discuss the importance of gradual reduction in

dosage, and she was dismayed to learn that her patient had been hospitalized after he

abruptly discontinued the medication when the football season ended (APA, 2011a;

McCrickerd, 2010; I. Singh & Kelleher, 2010).

􀀴 Consistent with Standard 10.10a, Terminating Treatment, a psychologist treating a

client/patient with a diagnosis of borderline disorder terminated therapy when she

realized the client/patient had formed an iatrogenic attachment to her that was clearly

interfering with any benefits that could be derived from the treatment. However, her

failure to provide appropriate pretermination counseling and referrals contributed to

the client’s/patient’s emergency hospitalization for suicidal risk (Standard 10.10c,

Terminating Treatment).

HMO

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

Chapter 6 Standards on Human Relations——97

Is Use of Aversion Therapies Unethical?

Aversion therapy involves the repeated association of a maladaptive behavior or

cognition with an aversive stimulus (e.g., electric shock, unpleasant images, nausea)

to eliminate pleasant associations or introduce negative associations with the undesirable

behavior. Aversion therapies have proved promising in treatments of drug

cravings, alcoholism, and pica (Bordnick, Elkins, Orr, Walters, & Thyer, 2004;

Ferreri, Tamm, & Wier, 2006; Thurber, 1985) and have been used with questionable

effectiveness for pedophilia (Hall & Hall, 2007). It is beyond the purview of this

volume to review literature evaluating the clinical efficacy of aversion therapies for

different disorders. However, even with evidence of clinical efficacy, aversion therapies

have and will continue to require ethical deliberation because they purposely

subject clients/patients to physical and emotional discomfort and distress. In so

doing, they raise the fundamental moral issue of balancing doing good against

doing no harm (Principle A: Beneficence and Nonmaleficence).

Psychologists should consider the following questions before engaging in aversion

therapy:

Have all empirically and clinically validated alternative therapeutic approaches

been attempted?

Is there empirical evidence that the aversive therapeutic approach has demonstrated

effectiveness with individuals who are similar to the client/patient in

mental health disorder, age, physical health, and other relevant factors?

(Standard 2.04, Bases for Scientific and Professional Judgments)

􀀵 Clarifying course requirements and establishing a timely and specific process for providing

feedback to students (Standard 7.06, Assessing Student and Supervisee Performance)

􀀵 Selecting and using valid and reliable assessment techniques appropriate to the nature

of the problem and characteristics of the testee to avoid misdiagnosis and inappropriate

services (Standards 9.01, Bases for Assessments, and 9.02, Use of Assessments)

􀀵 When appropriate, providing information beforehand to employees and others who

may be directly affected by a psychologist’s services to an organization (Standard 3.11,

Psychological Services Delivered To or Through Organizations)

􀀵 Acquiring adequate knowledge of relevant judicial or administrative rules prior to

performing forensic roles to avoid violating the legal rights of individuals involved in

litigation (Standard 2.01f, Boundaries of Competence)

􀀵 Taking steps to minimize harm when, during debriefing, a psychologist becomes aware

of participant distress created by the research procedure (Standard 8.08c, Debriefing)

􀀵 Becoming familiar with local social service, medical, and legal resources for clients/

patients and third parties who will be affected if a psychologist is ethically or legally

compelled to report child abuse, suicide risk, elder abuse, or intent to do physical harm

to another individual (Standard 4.05b, Disclosures)

􀀵 Monitoring patient’s physiological status when prescribing medications (with legal

prescribing authority), particularly when there is a physical condition that might complicate

the response to psychotropic medication or predispose a patient to experience

an adverse reaction (APA, 2011a).

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

98——PART II ENFORCEABLE STANDARDS

To what extent is the behavior endangering the life or seriously compromising

the well-being of the client/patient?

For this particular patient, will the discomfort and distress of the aversive

treatment outweigh its potential positive effects?

To what extent is the urgency defined by the needs of third parties rather than

the client/patient? (Standards 3.05, Multiple Relationships; 3.07, Third-Party

Requests for Services; and 3.08, Exploitative Relationships)

Am I competent to administer the aversive treatment? (Standards 2.01a,

Boundaries of Competence, and 2.05, Delegation of Work to Others)

If aversive treatment is the only remaining option to best serve the needs of

the client/patient, how can harm be minimized?

Have I established appropriate monitoring procedures and termination criteria?

􀀵 Prescribing psychologists trained in addiction treatments opened a group practice to

provide assessment and individual and group therapy for substance abuse and comorbid

disorders. Occasionally, some clients who were long-term cocaine users could not

overcome their cravings despite positive responses to therapy. In such cases, the team

would offer the client a chemical aversion therapy with empirical evidence of treatment

efficacy. The therapy was supervised by a member of the team who was a prescribing

psychologist and who had acquired additional training in this technique (see

also Standard 2.01, Competence).

􀀵 Prior to initiating the aversion therapy, clients/patients were required to undergo a

physical examination by a physician to rule out those for whom the treatment posed

a potential medical risk. The treatment consisted of drinking a saltwater solution

containing a chemical that would induce nausea. Saltwater was used to avoid creating

a negative association with water. As soon as the client began to feel nauseated,

he or she was instructed to ingest a placebo form of crack cocaine using drug paraphernalia.

A bucket was available for vomiting. Patients were monitored by a physician

assistant and the prescribing psychologist during the process and recovery for

any medical or iatrogenic psychological side effects (Standard 3.09, Cooperation With

Other Professionals). Following the recommended minimum number of sessions,

patients continued in individual psychotherapy, and positive and negative reactions to

the aversion therapy continued to be monitored (see Bordnick et al., 2004).

Need to Know: When HMOs

Refuse to Extend Coverage

When health maintenance organizations refuse psychologists’ request to extend coverage for

clients/patients whose reimbursement quotas have been reached, psychologists may be in

violation of Standard 3.04 if they (a) did not take reasonable steps at the outset of therapy to

estimate and communicate to patients and their insurance company the number of sessions

anticipated, (b) did not familiarize themselves with the insurers’ policy, (c) recognized a need

for continuing treatment but did not communicate with insurers in an adequate or timely

fashion, or (d) were unprepared to handle client/patient response to termination of services.

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

Chapter 6 Standards on Human Relations——99

Often, violation of Standard 3.04 will occur in connection with the violation of

other standards in this code that detail the actions required to perform psychological

activities in an ethically responsible manner. For example:

􀀴 Providing testimony on the poor parenting skills of an individual whom the psychologist

has never personally examined that contributed to that individual’s loss of child

custody (Standard 9.01b, Bases for Assessments)

􀀴 Engaging in a sexual relationship with a current therapy client/patient that was a

factor leading to the breakup of the client’s/patient’s marriage (Standard 10.05,

Sexual Intimacies With Current Therapy Clients/Patients)

􀀴 Asking students to relate their personal experience in psychotherapy to past and current

theories on mental health treatment when this requirement was not stipulated in

admissions or program materials, causing some students to drop out of the program

(Standard 7.04, Student Disclosure of Personal Information)

􀀴 Deceiving a research participant about procedures that the investigator expected

would cause some physical pain (Standard 8.07b, Deception in Research)

􀀴 Invalidating the life experience of clients from diverse cultural backgrounds by defining

their cultural values or behaviors as deviant or pathological and denying them culturally

appropriate care (D. W. Sue & Sue, 2003; Standard 2.01b, Boundaries of Competence).

Some contexts require more stringent protections against harm. For example,

psychologists working within institutions that use seclusion or physical restraint

techniques to treat violent episodes or other potentially injurious patient behaviors

must ensure that these extreme methods are employed only upon evidence of their

effectiveness, when other treatment alternatives have failed, and when the use of

such techniques is in the best interest of the patient and not for punishment, for

staff convenience or anxiety, or to reduce costs (Jerome, 1998).

􀀴 The director of psychological services for a children’s state psychiatric inpatient ward

approved the employment of time-out procedures to discipline patients who were disruptive

during educational classes. A special room was set up for this purpose. The director

did not, however, set guidelines for how the time-out procedure should be implemented.

For example, he failed to set limits on the length of time a child could be kept in the room

and not require staff monitoring, did not ensure the room was protected against fire

hazard, and did not develop policies that would permit patients to leave the room for

appropriate reasons. The director was appalled to learn that staff had not monitored

a 7-year-old who was kept in the room for over an hour and was discovered crying and

self-soiled (see, e.g., Dickens v. Johnson County Board of Education, 1987; Goss v. Lopez,

1975; Hayes v. Unified School District, 1989; Yell, 1994).

Psychotherapy and Counseling Harms

Psychologists should also be aware of psychotherapies or counseling techniques

that may cause harm (Barlow, 2010). If psychological interventions are powerful

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

100——PART II ENFORCEABLE STANDARDS

enough to improve mental health, it follows that they can be equally effective in worsening

it. In the normative practice of mental health treatment, the diversity of patient/

client mental health needs and the fluid nature of differential diagnosis will mean that

some therapeutic approaches will fail to help alleviate a mental health problem. In such

circumstances, psychologists will turn to other techniques, seek consultation, or offer

an appropriate referral. In other circumstances, negative symptoms are expected to

increase then subside during the natural course of evidence-based treatment (e.g.,

exposure therapy). When treating naturally deteriorating conditions (e.g., Alzheimer’s

disease), a worsening of symptoms does not necessarily indicate treatment harms

(Dimidjian & Hollon, 2010). By contrast, harmful psychotherapies are defined as those

that produce outcomes worse than what would have occurred without treatment

(Dimidjian & Hollon, 2010; Lilienfeld, 2007). Such harmful effects are easiest to detect

for mental health problems whose natural course is constant. In all these circumstances,

failure to terminate treatment when it becomes clear that continuation would

be harmful is a violation of Standard 3.04 and Standard 10.10a, Terminating Therapy.

Need to Know: How to Detect Harm

in Psychotherapy and Counseling

Psychologists should be aware of the evolving body of knowledge on potential contributors

to the harmful effects of psychotherapy and keep in mind the following suggestions

drawn from Beutler, Blatt, Alimohamed, Levy, and Angtuaco (2006), Castonguay, Boswell,

Constantino, Goldfried, and Hill (2010), and Lilienfeld (2007):

Obtain training in and keep up to date on the flexible use of interventions and

treatment alternatives to avoid premature use of clinical interpretations, rigid theoretical

frameworks, and singular treatment modalities.

Be familiar with the degree to which each client/patient and treatment setting match

those reported for a specific EBP and look for multiple knowledge sources as support

for different approaches (readers may also want to refer to the Need to Know section

on “Navigating the Online Search for Evidence-Based Practices” in Chapter 5).

Monitor change suggesting client/patient deterioration or lack of improvement;

continuously evaluate what works and what interferes with positive change.

Attend to treatment-relevant characteristics such as culture, sexual orientation,

religious beliefs, and disabilities and be aware of the possibility of over- or underdiagnosing

these clients’/patients’ mental health needs.

Carefully attend to client’s/patient’s disclosures of frustration with treatment and

use the information self-critically to evaluate the need to modify diagnosis, adjust

treatment strategy, or strengthen relational factors that may be jeopardizing the

therapeutic alliance.

Equipoise and Randomized Clinical Trials

Important questions of treatment efficacy and effectiveness driving the conduct

of randomized clinical trials (RCTs) for mental health treatments raise, by their very

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

Chapter 6 Standards on Human Relations——101

nature, the possibility that some participants will fail to respond to experimental

treatment conditions or experience a decline in mental health during the trial. To

comply with Standard 3.04, research psychologists should develop procedures to

identify and address such possibilities. Such steps can include (a) scientifically and

clinically informed inclusion and exclusion criteria for patient participation, (b) the

establishment of a data safety monitoring board to evaluate unanticipated risks that

may emerge during a clinical trial, and (c) prior to the initiation of the research,

establishing criteria based on anticipated risks for when a trial should be stopped to

protect the welfare of participants. For additional information on guidance from the

Office of Human Research Protections, readers can refer to http://www.hhs.gov/

ohrp/policy/advevntguid.html.

􀀵 There is professional and scientific disagreement over the risks and benefits of

prescribing methylphenidate (e.g., brand name Ritalin) for treatment of attentiondeficit/

hyperactivity disorder (ADHD) in children less than 6 years of age. An interdisciplinary

team of behavioral and prescribing psychologists sought to empirically

test the advantage of adding psychopharmaceutical treatment to CBT for 3- to

5-year-old children previously diagnosed with ADHD. To avoid unnecessarily exposing

children to the potential side effects of medication, the team decided that preschoolers

would first participate in a multi-week parent training and behavioral

treatment program and that only those children whose symptoms did not significantly

improve with the behavioral intervention would continue on to the medication

clinical trial.

3.05 Multiple Relationships

(a) A multiple relationship occurs when a psychologist is in a professional role with a person and

(1) at the same time is in another role with the same person, (2) at the same time is in a relationship

with a person closely associated with or related to the person with whom the psychologist

has the professional relationship, or (3) promises to enter into another relationship in the future

with the person or a person closely associated with or related to the person. A psychologist

refrains from entering into a multiple relationship if the multiple relationship could reasonably be

expected to impair the psychologist’s objectivity, competence, or effectiveness in performing his

or her functions as a psychologist, or otherwise risks exploitation or harm to the person with

whom the professional relationship exists.

Multiple relationships that would not reasonably be expected to cause impairment or risk

exploitation or harm are not unethical.

Individual psychologists may perform a variety of roles. For example, during

the course of a year, a psychologist might see clients/patients in private practice,

teach at a university, provide consultation services to an organization, and conduct

research. In some instances, these multiple roles will involve the same person or

persons who have a close relationship with one another and may be concurrent or

sequential.

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

102——PART II ENFORCEABLE STANDARDS

Not All Multiple Relationships Are Unethical

Multiple relationships that would not reasonably be expected to cause impairment

or risk exploitation or harm are not unethical. For example, it is not unethical

for psychologists to serve as clinical supervisors or dissertation mentors for students

enrolled in one of their graduate classes because supervision, mentoring, and

teaching are all educational roles.

Standard 3.05 does not prohibit attendance at a client’s/patient’s, student’s,

employee’s, or employer’s family funeral, wedding, or graduation; the participation

of a psychologist’s child in an athletic team coached by a client/patient; gift giving

or receiving with those with whom one has a professional role; or entering into a

social relationship with a colleague as long as these relationships would not reasonably

be expected to lead to role impairment, exploitation, or harm. Incidental

encounters with clients/patients at religious services, school events, restaurants,

health clubs, or similar places are also not unethical as long as psychologists react

to these encounters in a professional manner. Nonetheless, psychologists should

always consider whether the particular nature of a professional relationship might

lead to a client’s/patient’s misperceptions regarding an encounter. If so, it is advisable

to keep a record of such encounters. For example:

􀀵 A client with a fluctuating sense of reality coupled with strong romantic transference

feelings for a treating psychologist misinterpreted two incidental encounters with his

psychologist as planned romantic meetings. The client subsequently raised these incidents

in a sexual misconduct complaint against the psychologist. The psychologist’s

recorded notes, made immediately following each encounter, were effective evidence

against the invalid accusations.

Posttermination Nonsexual Relationships

The standard does not have an absolute prohibition against posttermination

nonsexual relationships with persons with whom psychologists have had a previous

professional relationship. However, such relationships are prohibited if the

posttermination relationship was promised during the course of the original

relationship or if the individual was exploited or harmed by the intent to have the

posttermination relationship. Psychologists should be aware that posttermination

relationships can become problematic when personal knowledge acquired

during the professional relationship becomes relevant to the new relationship

(see S. K. Anderson & Kitchener, 1996; Sommers-Flanagan, 2012).

􀀵 A psychologist in independent practice abruptly terminated therapy with a patient

who was an editor at a large publishing company so that the patient could review a

book manuscript that the psychologist had submitted to the company.

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

Chapter 6 Standards on Human Relations——103

Clients in Individual and Group Therapy

In most instances, treating clients/patients concurrently in individual and

group therapy does not represent a multiple relationship because the practitioner

is working in a therapeutic role in both contexts (R. E. Taylor & Gazda, 1991), and

Standard 3.05 does not prohibit such practice. Psychologists providing individual

and group therapy to the same clients/patients should consider instituting special

protections against inadvertently revealing to a therapy group information shared

by a client/patient in individual sessions. As in all types of professional practice,

psychologists should avoid recommending an additional form of therapy based on

the psychologist’s financial interests rather than the client’s/patient’s mental health

needs (Knauss & Knauss, 2012; Standard 3.06, Conflict of Interest).

Need to Know: Ethical “Hot Spots”

of Combined Therapy

Brabender and Fallon (2009) have identified ethical “hot spots” of combined therapy that

should be addressed at the outset of plans to engage clients/patients in individual and

group therapy. First, clients/patients should know that they have a choice in being offered

an additional therapy beyond what they expected, and their concerns about costs in time

and money should be respected and discussed (Standard 10.01, Informed Consent to

Therapy; 10.03, Group Therapy). Second, the psychologists should describe how private

information disclosed in individual therapy will be protected from transfer during group

sessions (Standard 4.02, Discussing the Limits of Confidentiality). Finally, psychologists

should explain their policies on client/patient decisions to choose to terminate one of the

treatment modalities (Standard 10.10a, Terminating Therapy).

Judging the Ethicality of Multiple Roles

Several authors have provided helpful decision-making models for judging

whether a multiple relationship may place the psychologist in violation of Standard

3.04 (Brownlee, 1996; Gottlieb, 1993; Oberlander & Barnett, 2005; Younggren &

Gottlieb, 2004). The majority looks at multiple relationships in terms of a continuum

of risk. From these models, the ethical appropriateness of a multiple relationship

becomes increasingly questionable with

increased incompatibility in role functions and objectives;

the greater power or prestige the psychologist has over the person with whom

there is a multiple role;

the greater the intimacy called for in the roles;

the longer the role relationships are anticipated to last;

the more vulnerable the client/patient, student, supervisee, or other subordinate

is to harm; and

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

104——PART II ENFORCEABLE STANDARDS

the extent to which engaging in the multiple relationship meets the needs of

the psychologist rather than the needs of the client/patient.

Potentially Unethical Multiple Relationships

Entering Into Another Role

Psychologists may encounter situations in which the opportunity to enter a new

relationship emerges with a person with whom they already have an established

professional role. The following examples illustrate multiple relationships that,

with rare exception, would be prohibited by Standard 3.05a because each situation

could reasonably be expected to impair psychologists’ ability to competently and

objectively perform their roles or lead to exploitation or harm.

􀀴 A psychologist agreed to see a student in the psychologist’s introductory psychology

course for brief private counseling for test anxiety. At the end of the semester, to avoid

jeopardizing the student’s growing academic self-confidence, the psychologist refrained

from giving the student a legitimate low grade for poor class performance. The psychologist

should have anticipated that the multiple relationship could impair her objectivity and

effectiveness as a teacher and create an unfair grading environment for the rest of the class.

􀀴 A company hired a psychologist for consultation on how to prepare employees for a

shift in management anticipated by the failing mental health of the chief executive

officer (CEO). A few months later, the psychologist agreed to a request by the board

of directors to counsel the CEO about retiring. The CEO did not want to retire and told

the psychologist about the coercive tactics used by the board. The psychologist realized

too late that this second role undermined both treatment and consultation

effectiveness because the counseling role played by the psychologist would be viewed

as either exploitative by the CEO or as disloyal by the board of directors.

􀀴 A school psychologist whose responsibilities in the school district included discussing

with parents the results of their children’s psychoeducational assessments regularly

recommended to parents that they bring their children to his private practice for

consultation and possible therapy.

􀀴 As part of their final class assignment, a psychologist required all students in her

undergraduate psychology class to participate in a federally funded research study

that she was conducting on college student drinking behaviors.

􀀴 A psychologist treating an inmate for anxiety disorder in a correctional facility agreed

with a request by the prison administrator to serve on a panel determining the

inmate’s parole eligibility (Anno, 2001).

􀀴 A graduate student interning at an inpatient psychiatric hospital asked her patients if

they would agree to participate in her dissertation research.

􀀴 An applied developmental psychologist conducting interview research on moral

development and adolescent health risk behaviors, often found herself giving advice

to adolescent female participants who asked for her help during the interviews.

Forensic Roles

Forensic psychologists may be called upon for a variety of assessment roles that

differ in their goals and responsibilities from those of treating psychologists.

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

Chapter 6 Standards on Human Relations——105

Whereas the responsibility of the treating psychologist is to help clients/patients

achieve mental health, the responsibility of forensic psychologists serving as experts

for the court, the defense, or plaintiff is to provide objective information to assist

the finder of facts in legal determinations. In most instances, psychologists who take

on both roles concurrently or sequentially will be in violation of Standard 3.05a.

For example, in the treatment context, the format, information sought, and

psychologist–client/patient relationship are guided by the psychologist’s professional

evaluation of client/patient needs. Information obtained in a standardized or

unstructured manner or in response to practitioner empathy and other elements of

the therapeutic alliance is a legitimate means of meeting treatment goals.

However, when mixed with the forensic role, the subjective nature of such inquiries

and the selectivity of information obtained impair the psychologist’s objectivity

and thus ability to fulfill forensic responsibilities. Moreover, the conflicting objectives

of the treating and forensic roles will be confusing and potentially intimidating to

clients/patients, thereby undermining the psychologist’s effectiveness in functioning

under either role. Gottlieb and Coleman (2012) advise forensic psychologists to play

only one role in legal matters and to notify parties if a role change is contemplated.

􀀴 A forensic psychologist was hired by the court to conduct a psychological evaluation

for a probation hearing of a man serving a jail sentence for spousal abuse. At the end

of the evaluation, the psychologist suggested that if the inmate were released, he and

his wife should consider seeing her for couple’s therapy.

Bush et al. (2006) suggest that one potential exception to multiple relationships

in forensic contexts may be seen in psychologists who transition from the role of

forensic evaluator to trial consultant. For example, in some contexts it might be

ethically permissible for a psychologist originally retained by a defense attorney to

evaluate a client to also perform consultative services to the attorney regarding the

testimony of other psychologists during a trial if (a) the psychologist provided

only an oral report on his or her diagnostic impressions and (b) the psychologist

would not be called on to provide court testimony. Psychologists should, however,

approach such a multiple relationship with caution if, by ingratiating themselves

with the attorney, they intentionally or unintentionally bias their evaluation or

otherwise violate Standard 3.05a, Multiple Relationships, or 3.06, Conflict of Interest.

(For additional discussion of the role of forensic experts, see the Hot Topics in

Chapters 8 and 12 on psychologists providing testimony in courts.)

Personal–Professional Boundary Crossings

Involving Clients/Patients, Students,

Research Participants, and Subordinates

Boundaries serve to support the effectiveness of psychologists’ work and create

a safe place for clients/patients, students, employees, and other subordinates to

benefit from the psychologists’ services (Burian & Slimp, 2000; Russell & Peterson,

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

106——PART II ENFORCEABLE STANDARDS

1998). Boundaries protect against a blurring of personal and professional domains

that could jeopardize psychologists’ objectivity and confidence of those with whom

they work that psychologists will act in their best interests. Unethical multiple relationships

often emerge after psychologists have engaged in a pattern that “progresses

from apparently benign and perhaps well-intended boundary crossings to

increasingly intrusive and harmful boundary violations and multiple relationships”

(Oberlander & Barnett, 2005, p. 51). Boundary crossings can thus place psychologists

on a slippery slope leading to ethical misconduct (Gutheil & Gabbard, 1993;

Norris, Gutheil, & Strasburger, 2003; Sommers-Flanagan, 2012).

Clients/patients, students, research participants, and supervisees have less experience,

knowledge, and power compared with psychologists providing assessment, treatment,

teaching, mentoring, or supervision. Consequently, they are unlikely to recognize

inappropriate boundary crossings or to express their concerns. It is the psychologist’s

responsibility to monitor and ensure appropriate boundaries between professional and

personal communications and relationships (Gottlieb, Robinson, & Younggren, 2007).

Sharing aspects of their personal history or current reactions to a situation with

those they work with is not unethical if psychologists limit these communications

to meet the therapeutic, educational, or supervisory needs of those they serve.

􀀵 A graduate student expressed to his dissertation mentor his feelings of inadequacy

and frustration upon learning that a manuscript he had submitted for publication was

rejected. The mentor described how she often reacted similarly when first receiving

such information but framed this disclosure within a “lesson” for the student on rising

above the initial emotion to objectively reflect on the review and improve his chances

of having a revised manuscript accepted.

􀀵 A psychologist in private practice was providing CBT to help a client conquer feelings

of inadequacy and panic attacks that were interfering with her desired career

advancement. After several sessions, the psychologist realized that the client’s distorted

belief regarding the ease with which other people and the psychologist, in

particular, attained their career goals was interfering with the effectiveness of the

treatment. The psychologist shared with the client a brief personal story regarding

how he experienced and reacted to a career obstacle, limiting the disclosure to elements

the client could use in framing her own career difficulties.

Boundary crossings can become boundary violations when psychologists share personal

information with clients/patients, students, or employees to satisfy their own needs.

􀀴 A psychologist repeatedly confided to his graduate research assistant about the economic

strains his marriage was placing on his personal and professional life. After

several weeks, the graduate student began to pay for the psychologist’s lunches when

they were delivered to the office.

􀀴 A psychologist providing services at a college counseling center was having difficulties

with her own college-aged son’s drinking habits. She began to share her concerns

about her son with her clients and sometimes asked their advice.

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

Chapter 6 Standards on Human Relations——107

Research

Boundary crossings can also lead to bidirectional coercion, exploitation, or

harm. For example, the intimacy between researchers and study participants inherent

in ethnographic and participant observation research can create ambiguous or

blurred personal–professional boundaries that can threaten the validity of data

collected (Fisher, 2004, 2011). Study participants may feel bound by a personal

relationship with an investigator to continue in a research project they find distressing,

or investigators may feel pressured to yield to participant demands for involvement

in illegal behaviors or for money or other resources above those allocated for

participation in the research (Singer et al., 1999).

􀀴 A psychologist was conducting ethnographic research on the lives of female sex workers

who were also raising young children. In an effort to establish a sense of trust with

the sex workers, she spent many months in the five-block radius where they worked,

sharing stories with them about her own parenting experiences. One day, when the

police were conducting a drug raid in the area, a participant the psychologist had

interviewed numerous times begged the psychologist to hold her marijuana before

the police searched her, crying that she would lose her child if the drugs were discovered.

The psychologist felt she had no choice but to agree to hide the drugs because

of the personal worries about the safety of her own children that she had shared with

the participant (adapted from Fisher, 2011).

Nonsexual Physical Contact

Nonsexual physical contact with clients/patients, students, or others over whom

the psychologist has professional authority can also lead to role misperceptions that

interfere with the psychologist’s professional functions. While Standard 3.05 does

not prohibit psychologists from hugging, handholding, or putting an arm around

those with whom they work in response to a special event (e.g., graduation, termination

of therapy, promotion), or showing empathy for emotional crises (e.g.,

death in the family, recounting of an intense emotional event), such actions can be

the first step toward an easing of boundaries that could lead to an unethical multiple

relationship.

Whenever such circumstances arise, psychologists should evaluate, before

they act, the appropriateness of the physical contact by asking the following

questions:

Is the initiation of physical contact consistent with the professional goals of

the relationship?

How might the contact serve to strengthen or jeopardize the future functioning

of the psychologist’s role?

How will the contact be perceived by the recipient?

Does the act serve the immediate needs of the psychologist rather than the

immediate or long-term needs of the client/patient, student, or supervisee?

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

108——PART II ENFORCEABLE STANDARDS

Is the physical contact a substitute for more professionally appropriate

behaviors?

Is the physical contact part of a continuing pattern of behavior that may

reflect the psychologists’ personal problems or conflicts?

Need to Know: Professional Boundaries

and Self-Disclosure Over the Internet

The Internet has complicated psychologists’ control over access to personal information.

Psychologists can control some information disclosed on the Internet through

carefully crafted professional blogs, participation on professional or scientific listservs,

and credentials or course curricula posted on individual or institutional websites.

However, accidental self-disclosure (Zur, Williams, Lehavot, & Knapp, 2009) can occur

when clients/patients, students, employees, or others (a) pay for legal online background

checks that may include information on divorce or credit ratings, (b) conduct

illegal searches of cell phone records, or (c) use search engines to find information that

the psychologist may not be aware is posted online. Even when psychologists refuse

“friending” requests, it is increasingly easy for individuals to find information on social

networks such as Facebook through the millions of interconnected links and “mutual

friends” who may have personal postings from and photos of the psychologist on their

websites (Luo, 2009; L. Taylor, McMinn, Bufford, & Change, 2010; Zur et al., 2009).

Given the risks of accidental self-disclosure, psychologists should consider the following

to limit access to personal information (Barnett, 2008; Lehavot, Barnett, & Powers,

2010; Nicholson, 2011):

Set one’s social network settings to restrict access to specifically authorized

visitors only.

Consider whether posted personal information, if accessed, would cause harm to

those with whom you work; undermine your therapeutic, teaching, consultation, or

research effectiveness; or compromise the public’s trust in the discipline.

Periodically search one’s name online using different combinations (e.g., Dr. Jones,

Edward Jones, Jones family).

Consult with experts on how to remove personal or inaccurate information from

the Internet.

When appropriate discuss your Internet policies during informed consent or the

beginning of other professional relationships (see “Need to Know: Setting an Internet

Search and Social Media Policy During Informed Consent” in Chapter 13).

Relationships With Others

Psychologists also encounter situations in which a person closely associated with

someone with whom they have a professional role seeks to enter into a similar professional

relationship. For example, the roommate of a current psychotherapy client/

patient might ask the psychologist for an appointment to begin psychotherapy. A

CEO of a company that hires a psychologist to conduct personnel evaluations might

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

Chapter 6 Standards on Human Relations——109

ask the psychologist to administer psychological tests to the CEO’s child to determine

whether the child has a learning disability. With few exceptions, entering into

such relationships would risk a violation of Standard 3.05a because it could reasonably

be expected that the psychologist’s ability to make appropriate and objective

judgments would be impaired, which in turn would jeopardize the effectiveness of

services provided and result in harm.

Receiving referrals from current or recent clients/patients should raise ethical

red flags. In many instances, accepting into treatment a friend, relative, or others

referred by a current client can create a real or perceived intrusion on the psychologist–

patient relationship. For example, a current client/patient may question whether the

psychologist has information about him or her gained from the person he or she

referred or whether the psychologist is siding with one person or the other if there

is a social conflict. Psychologists must also guard against exploiting clients/patients

by explicitly or implicitly encouraging referrals to expand their practice (see also

Standard 3.06, Conflict of Interest).

Some have suggested that treating psychologists should consider a referral from

a current client/patient in the same way they would evaluate the therapeutic meaning

of a “gift” (E. Shapiro & Ginzberg, 2003). In all circumstances, psychologists

must evaluate the extent to which accepting a referral can impair their objectivity

and conduct of their work or lead to exploitation or harm. One way of addressing

this issue is to clearly state to current patients the psychologist’s policy of not

accepting patient referrals and, if a situation arises requiring an immediate need for

treatment, to provide a professional referral to another psychologist (see also

Standard 2.02, Providing Services in Emergencies).

When practicing psychologists receive referrals from former clients/patients, it is

prudent to consider (a) whether the former client/patient may need the psychologist’s

services in the future, (b) whether information obtained about the new referral

during the former client’s/patient’s therapy is likely to impair the psychologist’s

objectivity, and (c) the extent to which the new referral’s beliefs about the former

client’s/patient’s relationship with the psychologist is likely to interfere with treatment

effectiveness.

Preexisting Personal Relationships

Psychologists may also encounter situations in which they are asked to take on a

professional role with someone with whom they have had a preexisting personal

relationship. Such multiple relationships are often unethical because the preexisting

relationship would reasonably be expected to impair the psychologist’s objectivity

and effectiveness.

􀀴 A psychologist agrees to spend a few sessions helping his nephew overcome anxiety

about going to school.

􀀴 At a colleague’s request, a psychologist agrees to administer a battery of tests to

assess whether the colleague has adult attention deficit disorder.

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

110——PART II ENFORCEABLE STANDARDS

Sexual Multiple Relationships

Sexual relationships with individuals with whom psychologists have a current

professional relationship are always unethical. Because of the strong potential for

harm involved in such multiple relationships, they are specifically addressed in

several standards of the Ethics Code that will be covered in greater detail in

Chapters 10 and 13 (Standards 7.07, Sexual Relationships With Students and

Supervisees; 10.05, Sexual Intimacies With Current Therapy Clients/Patients; 10.06,

Sexual Intimacies With Relatives or Significant Others of Current Therapy Clients/

Patients; 10.07, Therapy With Former Sexual Partners; and 10.08, Sexual Intimacies

With Former Therapy Clients/Patients).

“Reasonably Expected”

It is important to note that the phrase “could reasonably be expected” indicates

that violations of Standard 3.05a may be judged not only by whether actual impairment,

harm, or exploitation has occurred but also by whether most psychologists

engaged in similar activities in similar circumstances would determine that entering

into such a multiple relationship would be expected to lead to such harms.

􀀵 A judge asked a psychologist who had conducted a custody evaluation to provide

6-month mandated family counseling for the couple involved followed by a reevaluation

for custody. The psychologist explained to the judge that providing family counseling

to individuals whose parenting skills the psychologist would later have to

evaluate could reasonably be expected to impair her ability to form an objective

opinion independent of knowledge gained and the professional investment made in

the counseling sessions. She also explained that such a multiple relationship could

impair her effectiveness as a counselor if the parents refrained from honest engagement

in the counseling sessions for fear that comments made would be used against

them during the custody assessment. The judge agreed to assign the family to another

psychologist for counseling.

Unavoidable Multiple Relationships

In some situations, it may not be possible or reasonable to avoid multiple relationships.

Psychologists working in rural communities, small towns, American

Indian reservations, or small insulated religious communities or who are qualified

to provide services to members of unique ethnic or language groups for which

alternative psychological services are not available would not be in violation of this

standard if they took reasonable steps to protect their objectivity and effectiveness

and the possibility of exploitation and harm (Werth et al., 2010).

Such steps might include seeking consultation by phone from a colleague to

help ensure objectivity and taking extra precautions to protect the confidentiality

of each individual with whom the psychologist works. Psychologists can also

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

Chapter 6 Standards on Human Relations——111

explain to individuals involved the ethical challenges of the multiple relationships,

describe the steps the psychologist will take to mitigate these risks, and

encourage individuals to alert the psychologist to multiple relational situations of

which the psychologist might not be aware and that might place his or her effectiveness

at risk.

􀀵 A rabbi in a small orthodox Jewish community also served as the community’s sole

licensed clinical psychologist. The psychologist was careful to clearly articulate to his

clients the separation of his role as a psychologist and his role as their rabbi. His work

benefited from his ability to apply his understanding of the orthodox faith and community

culture to help clients/patients with some of the unique psychological issues

raised. He had been treating a young woman in the community for depression when

it became clear that a primary contributor to her distress was her deep questioning of

her faith. The psychologist knew from his years in the community that abandoning

orthodox tenets would most likely result in the woman being ostracized by her family

and community. As a rabbi, the psychologist had experience helping individuals

grapple with doubts about their faith. However, despite the woman’s requests, he was

unwilling to engage in this rabbinical role as a part of the therapy, believing that helping

the woman maintain her faith would be incompatible with his responsibility as a

psychologist to help her examine the psychological facets of her conflicted feelings.

The rabbi contacted the director of an orthodox rabbinical school who helped him

identify an advanced student with experience in Jewish communal service who was

willing to come to the community once a week to provide a seminar on Jewish studies

and meet individually with congregants about issues of faith. The psychologist

explained the role conflict to his patient. They agreed that she would continue to see

the psychologist for psychotherapy and meet with the visiting rabbinical student to

discuss specific issues of faith. Readers may also wish to refer to the Hot Topic in

Chapter 13 on the role of religion and spirituality in psychotherapy.

Correctional and Military Psychologists

Psychologists working in correctional settings and those enlisted in the military

often face unique multiple relationship challenges. In some prisons, correctional

administrators believe that all employees should provide services as officers. As

detailed by Weinberger and Sreenivasan (2003), psychologists in such settings may

be asked to search for contraband, use a firearm, patrol to prevent escapes, coordinate

inmate movement, and deal with crises unrelated to their role as a psychologist.

Any one of these roles has the potential to undermine the therapeutic

relationship a psychologist establishes with individual inmates by blurring the roles

of care provider and security officer. Such potentially harmful multiple relationships

are also inconsistent with the Standards for Psychological Services in Jails,

Prisons, Correctional Facilities, and Agencies (Althouse, 2000).

As required by Standard 1.03, Conflicts Between Ethics and Organizational

Demands, prior to taking a position as a treating psychologist or whenever correctional

psychologists are asked to engage in a role that will compromise their health

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

112——PART II ENFORCEABLE STANDARDS

provider responsibilities, they should clarify the nature of the conflict to the administrator,

make known their commitment to the Ethics Code, and attempt to resolve

the conflict by taking steps to ensure that they do not engage in multiple roles that

will interfere with the provision of psychological services.

􀀵 A psychologist working in a correctional facility had successfully established his primary

role as that of mental health treatment provider with both prison officials and

inmates. He was not required to search his patients for contraband or to perform any

other security-related activities. As required of all facility staff, he received training in

the use of firearms and techniques to disarm prisoners who had weapons. On one

occasion, several newly admitted inmates suddenly began to attack some of the older

prisoners with homemade knives. As one of the few correctional staff members present

at the scene, the psychologist assisted the security staff in disarming the inmates.

Although none of the attacking inmates were in treatment with him, he did discuss

the incident with his current patients to address any concerns they might have about

the therapeutic relationship.

Psychologists in the military face additional challenges (Kennedy & Johnson,

2009). W. B. Johnson, Bacho, Heim, and Ralph (2006) highlight multiple role obligations

that may create a conflict between responsibilities to individual military

clients/patients and to their military organization: (a) as commissioned officers,

psychologists’ primary obligation is to the military mission; (b) embedded psychologists

must promote the fighting power and combat readiness of individual

military personnel and the combat unit as a whole; (c) since many military psychologists

are the sole mental health providers for their unit, there is less room for

choice of alternative treatment providers; (d) there is less control and choice

regarding shifts between therapeutic and administrative role relationships (e.g.,

seeing as a patient a member about whom the psychologist previously had to render

an administrative decision); and (e) like rural communities, military communities

are often small, with military psychologists having social relationships with

individuals who may at some point become patients.

To minimize the potential harm that could emerge from such multiple relationships,

Johnson et al. (2006) suggest that military psychologists (a) strive for a neutral

position in the community, avoiding high-profile social positions; (b) assume

that every member of the community is a potential client/patient and attempt to

establish appropriate boundaries accordingly, for example, limiting self-disclosures

that would be expected in common social circumstances; (c) provide informed

consent immediately if a nontherapeutic role relationship transitions into a therapeutic

one; (d) be conservative in the information one “needs to know” in the

therapeutic role to avoid to the extent feasible threats to confidentiality that may

emerge when an administrative role is required; (e) collaborate with clients/

patients on how best to handle role transitions when possible and appropriate; and

(f) carefully document multiple role conflicts, how they were handled, and the

rationale for such decisions.

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

Chapter 6 Standards on Human Relations——113

(b) If a psychologist finds that, due to unforeseen factors, a potentially harmful multiple relationship

has arisen, the psychologist takes reasonable steps to resolve it with due regard for the best

interests of the affected person and maximal compliance with the Ethics Code.

There will be instances when psychologists discover that they are involved in a

potentially harmful multiple relationship of which they had been unaware. Standard

3.05b requires that psychologists take reasonable steps to resolve the potential harms

that might arise from such relationships, recognizing that the best interests of the

affected person and maximal compliance with other standards in the Ethics Code

may sometimes require psychologists to remain in the multiple roles.

􀀵 A military psychologist provided therapy to an enlisted officer who was ordered to enter

treatment for difficulties in job-related performance. During treatment, the client and

psychologist were assigned to a field exercise in which the client would be under

the psychologist’s command. To reassign the client to a different officer for the exercise,

the psychologist would need to speak with a superior who was not a mental health

worker. Recognizing that the client’s involvement in therapy would have to be revealed

in such a discussion, the psychologist explained the situation to the enlisted member

and asked permission to discuss the situation with her superiors. The client refused to

give permission. The psychologist was the only mental health professional on the base,

so transferring the client to another provider was not an option. The psychologist therefore

developed a specific plan with the client for how they would relate to each other

during the field exercise and how they would discuss in therapy issues that arose. (This

case is adapted from one of four military cases provided by Staal & King, 2000.)

􀀵 A psychologist responsible for conducting individual assessments of candidates for an

executive-level position discovered that one of the candidates was a close friend’s

husband. Because information about this prior relationship was neither confidential

nor harmful to the candidate, the psychologist explained the situation to company

executives and worked with the organization to assign that particular promotion

evaluation to another qualified professional.

􀀵 A psychologist working at a university counseling center discovered that a counseling

client had enrolled in a large undergraduate class the psychologist was going to teach.

The psychologist discussed the potential conflict with the client and attempted to help

him enroll in a different class. However, the client was a senior and needed the class

to complete his major requirements. In addition, there were no appropriate referrals

for the student at the counseling center. Without revealing the student’s identity, the

psychologist discussed her options with the department chair. They concluded that

because the class was very large, the psychologist could take the following steps to

protect her objectivity and effectiveness as both a teacher and a counselor: (a) a

graduate teaching assistant would be responsible for grading exams and for calculating

the final course grade based on the average of scores on the exams and (b) the

psychologist would monitor the situation during counseling sessions and seek consultation

if problems arose.

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

114——PART II ENFORCEABLE STANDARDS

(c) When psychologists are required by law, institutional policy, or extraordinary circumstances

to serve in more than one role in judicial or administrative proceedings, at the outset they

clarify role expectations and the extent of confidentiality and thereafter as changes occur. (See

also Standards 3.04, Avoiding Harm, and 3.07, Third-Party Requests for Services.)

Standard 3.05c applies to instances when psychologists are required to serve in

more than one role in judicial or administrative proceedings because of institutional

policy or extraordinary circumstances. This standard does not permit psychologists

to take on these multiple roles if such a situation can be avoided. When

such multiple roles cannot be avoided, Standard 3.05c requires, as soon as possible

and thereafter as changes occur, that psychologists clarify to all parties involved the

roles that the psychologist is expected to perform and the extent and limits of confidentiality

that can be anticipated by taking on these multiple roles.

In most situations, psychologists are expected to avoid multiple relationships

in forensically relevant situations or to resolve such relationships when they

unexpectedly occur (Standard 3.05a and b). When such circumstances arise (e.g.,

performing a custody evaluation and then providing court-mandated family

therapy for the couple involved), the conflict can often be resolved by explaining

to a judge or institutional administrator the ethically problematic nature of the

multiple relationship (Standards 1.02, Conflicts Between Ethics and Law,

Regulations, and Other Governing Legal Authority; 1.03, Conflicts Between

Ethics and Organizational Demands).

􀀵 A psychologist in independent practice became aware that his neighbor had begun dating

one of the psychologist’s psychotherapy patients. Although telling the patient about

the social relationship could cause distress, it was likely that the patient would find out

about the relationship during conversations with the neighbor. The psychologist considered

reducing his social exchanges with the neighbor, but this proved infeasible. After

seeking consultation from a colleague, the psychologist decided that he could not ensure

therapeutic objectivity or effectiveness if the situation continued. He decided to explain

the situation to the patient, provide a referral, and assist the transition to a new therapist

during pretermination counseling (see also Standard 10.10, Terminating Therapy).

􀀵 A consulting psychologist developed a company’s sexual harassment policy. After the

policy was approved and implemented, the psychologist took on the position of counseling

employees experiencing sexual harassment. One of the psychologist’s clients

then filed a sexual harassment suit against the company. The psychologist was called

on by the defense to testify as an expert witness for the company’s sexual harassment

policy and by the plaintiff as a fact witness about the stress and anxiety observed during

counseling sessions. The psychologist (a) immediately disclosed to the company and

the employee the nature of the multiple relationship; (b) described to both the problems

that testifying might raise, including the limits of maintaining the confidentiality

of information acquired from either the consulting or counseling roles; and (c) ceased

providing sexual harassment counseling services for employees. Neither party agreed

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

Chapter 6 Standards on Human Relations——115

3.06 Conflict of Interest

Psychologists refrain from taking on a professional role when personal, scientific, professional, legal,

financial, or other interests or relationships could reasonably be expected to (1) impair their objectivity,

competence, or effectiveness in performing their functions as psychologists or (2) expose the

person or organization with whom the professional relationship exists to harm or exploitation.

Psychologists strive to benefit from and establish relationships of trust with those with

whom they work through the exercise of professional and scientific judgments based on

their training and experience and established knowledge of the discipline (Principle A:

Beneficence and Nonmaleficence and Principle B: Fidelity and Responsibility).

Standard 3.06 prohibits psychologists from taking on a professional role when competing

professional, personal, financial, legal, or other interests or relationships could reasonably

be expected to impair their objectivity, competence, or ability to effectively

perform this role. Psychologists, especially those with prescription privileges, should

also be sensitive to the effect of gifts from pharmaceutical or others who might exert

influence on professional decisions (Gold & Applebaum, 2011). Examples of conflicts

of interest sufficient to compromise the psychologist’s judgments include the following:

􀀴 Irrespective of patients’ treatment needs, to save money, a psychologist reduced the

number of sessions for certain patients after he had exceeded his yearly compensation

under a capitated contract with an HMO (see the Hot Topic in Chapter 9, “Managing

the Ethics of Managed Care”).

􀀴 A member of a faculty-hiring committee refused to recuse herself from voting when a

friend applied for the position under the committee’s consideration.

􀀴 A psychologist in private practice agreed to be paid $1,000 for each patient he

referred for participation in a psychopharmaceutical treatment study.

􀀴 A research psychologist agreed to provide expert testimony on a contingent fee basis,

thereby compromising her role as advocate for the scientific data.

􀀴 A psychologist who had just purchased biofeedback equipment for his practice began

to overstate the effectiveness of biofeedback to his clients.

􀀴 A prescribing psychologist failed to disclose to patients her substantial financial

investment in the company that manufactured the medication the psychologist frequently

recommended.

􀀴 A psychologist used his professional website to recommend Internet mental health

services in which he had an undisclosed financial interest.

􀀴 A school psychologist agreed to conduct a record review for the educational placement

of the child of the president of a foundation that contributed heavily to the

private school that employed the psychologist.

to withdraw its request to the judge for the psychologist’s testimony. The psychologist

wrote a letter to the judge explaining the conflicting roles and asked to be recused from

testifying (see Hellkamp & Lewis, 1995, for further discussion of this type of dilemma).

HMO

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

116——PART II ENFORCEABLE STANDARDS

Conflicts of interest can extend to financial or other gains that accrue to psychologists

indirectly through the effect of their decisions on the interests of their

family members:

􀀴 An educational psychologist encouraged a school system she was consulting to purchase

learning software from a company that employed her husband.

􀀴 An organizational psychologist was hired by a company to provide confidential support

and referral services for employees with substance abuse problems. The psychologist

would refer employees he counseled to a private mental health group

practice in which his wife was a member.

􀀴 A research psychologist on the board of a private foundation encouraged the foundation

to fund a colleague’s proposal from which he would be paid as a statistical

consultant.

􀀴 A psychologist accepted a position on the board of directors from a company for

which she was currently conducting an independent evaluation of employee

productivity.

􀀴 A psychologist took on a psychotherapy client who was a financial analyst at the

brokerage company the psychologist used for his personal investments.

􀀴 A psychologist serving on her university’s IRB gave in to pressure to approve a study

with ethically questionable procedures because it would bring a substantial amount

of funding dollars to the university.

􀀵 A school psychologist refused the district superintendent’s request that she conduct

training sessions for teachers at an overcrowded school that would result in the misapplication

of behavioral principles to keep students docile and quiet.

Psychologists also have a fiduciary responsibility to avoid actions that would create

public distrust in the integrity of psychological science and practice (Principle B:

Fidelity and Responsibility). Accordingly, Standard 3.06 also prohibits taking on a

role that would expose a person or organization with whom a psychologist already

works to harm or exploitation. For example:

Psychologists in administrative positions have a responsibility to resist explicit

or implicit pressure to bias decisions regarding the adequacy of research participant

or patient protections to meet the needs of the institution’s financial interests.

Organizational and consulting psychologists should be wary of situations in

which an employer may request the psychologist to assist with managerial directives

that may be ethically inappropriate and harmful to the wellbeing of employees

(Lefkowitz, 2012).

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

Chapter 6 Standards on Human Relations——117

Conflicts of Interest in Forensic Practice

Psychologists seek to promote accuracy and truthfulness in their work (Principle C:

Integrity). Forensic psychologists hired to provide expert testimony based on forensic

assessment or research relevant to the legal decision need to be aware of potential

conflicts of interest that may impair their objectivity or lead them to distort

their testimony. For example, psychologists providing expert testimony should not

provide such services on the basis of contingent fees (fees adjusted to whether a case

is won or lost) since this can exert pressure on psychologists to intentionally or

unintentionally modify their reports or testimony in favor of the retaining party.

However, if a psychologist is serving as a consultant to a legal team and will not be

testifying in court, a contingency fee may not be unethical as long as it does not lead

psychologists to distort facts in giving their advice (Heilbrun, 2001). Psychologists

should also avoid charging higher fees for testimony since this may motivate writing

a report that is more likely to lead to a request to testify (Heilbrun, 2001). Bush

et al. (2006) suggest psychologists set fixed rates (which may be required in some

states) and bill an hourly rate consistent for all activities.

Forensic psychologists hired by the defense team must also avoid explicit or

subtle pressure to use more or less sensitive symptom validation measures to assess

the mental status of the defendant. Psychologists should not submit to pressure by

a legal team to modify a submitted report. Amendments to the original report may

be added to correct factual errors, and if a report is rewritten, the rationale for the

changes should be given within the report (Bush et al., 2006; Martelli, Bush, &

Sasler, 2003). Interested readers may also refer to the Chapter 8 Hot Topic on

“Avoiding False and Deceptive Statements in Scientific and Clinical Expert

Testimony.”

Corporate Funding and Conflicts of Interest

in Research, Teaching, and Practice

The APA Task Force on External Funding (http://www.apa.org/pubs/info/reports/

external-funding.aspx) provides a detailed history of conflicts of interest in related

fields and provides specific recommendations for psychology (see also Pachter, Fox,

Zimbardo, & Antonuccio, 2007). Recommendations include the following:

When research is industry sponsored, psychologists should ensure that they

have input into study design, independent access to raw data, and a role in

manuscript submission.

Full public disclosure regarding financial conflicts of interest should be

included in all public statements.

Psychologists should be aware and guard against potential biases inherent in

accepting sponsor-provided inducements that might affect their selection of

textbooks or assessment instruments.

Practitioners should be alert to the influence on clients/patients of sponsorprovided

materials (e.g., mugs, pens, notepads) that might suggest endorsement

of the sponsor’s products.

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

118——PART II ENFORCEABLE STANDARDS

Many federal agencies, professional and scientific organizations, and academic

and other institutions have conflict of interest policies of which psychologists

should be aware.

The National Institutes of Health (NIH) Office of Extramural Research

requires every institution receiving Public Health Service (PHS) research

grants to have written guidelines for the avoidance and institutional review

of conflict of interest. These guidelines must reflect state and local laws and

cover financial interests, gifts, gratuities and favors, nepotism, political participation,

and bribery. In addition, employees accepting grants or contracts

are expected to be knowledgeable of the granting and contracting organization’s

conflict-of-interest policy and to abide by it (http://grants.nih.gov/

grants/policy/coi/). In addition, the PHS Regulations 42 CFR Part 50

(Subpart F) and 45 CFR Part 94 provide conflict-of-interest guidelines for

individual investigators (http://grants.nih.gov/grants/guide/notice-files/

not95-179.html).

The APA Editor’s Handbook: Operating Procedures and Policies for APA

Publications (APA, 2006, Policy 1.03) requires that journal reviewers and editors

avoid either real or apparent conflict of interest by declining to review

submitted manuscripts from recent collaborators, students, or members of

their institutions or work from which they might obtain financial gain. When

such potential conflicts of interest arise or when editors or associate editors

submit their own work to the journal they edit, the Handbook recommends

that the editor (a) request a well-qualified individual to serve as ad hoc Action

Editor, (b) set up a process that ensures the Action Editor’s independence, and

(c) identify the Action Editor in the publication of the article. APA also

requires all authors to submit a Full Disclosure of Interests Form that certifies

whether the psychologist or his or her immediate family members have significant

financial or product interests related to information provided in the

manuscript or other sources of negative or positive bias (www.apa.org/pubs/

authors/disclosure_of_interests.pdf).

The APA Committee on Accreditation’s Conflict of Interest Policy for Site

Visitors includes prohibitions against even the appearance of a conflict of

interest for committee members and faculty in the program being visited.

Possible conflicts include former employment or enrollment in the program

or a family connection or close friend or professional colleague in the program

(http://www.apa.org/ed/accreditation/visits/conflict.aspx).

The NASP’s Professional Conduct Manual requires psychologists to avoid conflicts

of interest by recognizing the importance of ethical standards and the

separation of roles and by taking full responsibility for protecting and informing

the consumer of all potential concerns (NASP, 2010, V.A.1).

According to the SGFP (AP-LS Committee on the Revision of the Specialty

Guidelines for Forensic Psychologists, 2010), psychologists should not provide

services to parties to a legal proceeding on the basis of a contingent fee

(SGFP, IV.B).

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

Chapter 6 Standards on Human Relations——119

3.07 Third-Party Requests for Services

When psychologists agree to provide services to a person or entity at the request of a third party,

psychologists attempt to clarify at the outset of the service the nature of the relationship with all

individuals or organizations involved. This clarification includes the role of the psychologist (e.g.,

therapist, consultant, diagnostician, or expert witness), an identification of who is the client, the

probable uses of the services provided or the information obtained, and the fact that there may

be limits to confidentiality. (See also Standards 3.05, Multiple Relationships, and 4.02, Discussing

the Limits of Confidentiality.)

Psychologists are often asked to conduct an assessment, provide psychotherapy,

or testify in court by third parties who themselves will not be directly involved in

the evaluation, treatment, or testimony.

In all these cases, Standard 3.07 requires psychologists at the outset of services

to explain to both the third party and those individuals who will receive psychological

services the nature of the psychologist’s relationship with all individuals or

organizations involved. This includes providing information about the role of the

psychologist (i.e., therapist, consultant, diagnostician, expert witness), identifying

whether the third party or the individual receiving the services is the client, who

will receive information about the services, and probable uses of information

gained or services provided.

􀀵 A company asked a psychologist to conduct preemployment evaluations of potential

employees. The psychologist informed each applicant evaluated that she was working

for the company, that the company would receive the test results, and that the information

would be used in hiring decisions.

􀀵 A school district hired a psychologist to evaluate students for educational placement.

The psychologist first clarified state and federal laws on parental rights regarding

educational assessments, communicated this information to the school superintendent

and the child’s guardian(s), and explained the nature and use of the assessments

and the confidentiality and reporting procedures the psychologist would use.

􀀵 A legal guardian requested behavioral treatment for her 30-year-old developmentally

disabled adult child because of difficulties he was experiencing at the sheltered workshop

where he worked. At the outset of services, using language compatible with the

client’s/patient’s intellectual level, the psychologist informed the client/patient that

the guardian had requested the treatment, explained the purpose of the treatment,

and indicated the extent to which the guardian would have access to confidential

information and how such information might be used.

􀀵 A defense attorney hired a psychologist to conduct an independent evaluation of a

plaintiff who claimed that the attorney’s client had caused her emotional harm. The

plaintiff agreed to be evaluated. The psychologist first explained to the plaintiff that

the defense attorney was the client and that all information would be shared with the

attorney and possibly used by the attorney to refute the plaintiff’s allegations in court.

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

120——PART II ENFORCEABLE STANDARDS

Legal Representatives Seeking to

Retain a Forensic Psychologist

In many instances, forensic psychologists will be retained by the attorney

representing the legal party’s interests. In such instances, the attorney is the psychologist’s

client. During the initial consultation with a legal representative seeking

the psychologist’s forensic services, psychologists should consider providing

the following information: (a) the fee structure for anticipated services; (b) previous

or current obligations, activities, or relationships that might be perceived as

conflicts of interest; (c) level and limitations of competence to provide forensic

services requested; and (d) any other information that might reasonably be

expected to influence the decision to contract with the psychologist (see AP-LS

Committee on the Revision of the Specialty Guidelines for Forensic Psychologists,

2010; Standard 6.04a, Fees and Financial Arrangements).

Implications of HIPAA

Psychologists planning to share information with third parties should also carefully

consider whether such information is included under the HIPAA definition of

Protected Health Information (PHI), whether HIPAA regulations require prior

patient authorization for such release, or whether the authorization requirement

can be waived by the legal prerogatives of the third party (45 CFR 164.508 and

164.512). Psychologists should then clarify beforehand to both the third party and

recipient of services the HIPAA requirements for the release of PHI (see also “A

Word About HIPAA” in the Preface of this book).

3.08 Exploitative Relationships

Psychologists do not exploit persons over whom they have supervisory, evaluative, or other

authority such as clients/patients, students, supervisees, research participants, and employees.

(See also Standards 3.05, Multiple Relationships; 6.04, Fees and Financial Arrangements; 6.05,

Barter With Clients/Patients; 7.07, Sexual Relationships With Students and Supervisees; 10.05,

Sexual Intimacies With Current Therapy Clients/Patients; 10.06, Sexual Intimacies With Relatives

Once the evaluation commenced, the psychologist avoided using techniques that

would encourage the plaintiff to respond to the psychologist as a psychotherapist

(Hess, 1998).

􀀵 A judge ordered a convicted sex offender to receive therapy as a condition of parole.

The psychologist assigned to provide the therapy explained to the parolee that all

information revealed during therapy would be provided to the court and might be

used to rescind parole.

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

Chapter 6 Standards on Human Relations——121

or Significant Others of Current Therapy Clients/Patients; 10.07, Therapy With Former Sexual Partners;

and 10.08, Sexual Intimacies With Former Therapy Clients/Patients.)

Standard 3.08 prohibits psychologists from taking unfair advantage of or manipulating

for their own personal use or satisfaction students, supervisees, clients/

patients, research participants, employees, or others over whom they have authority.

The following are examples of actions that would violate this standard:

􀀴 Repeatedly requiring graduate assistants to work overtime without additional

compensation

􀀴 Requiring employees to run a psychologist’s personal errands

􀀴 Taking advantage of company billing loopholes to inflate rates for consulting services

􀀴 Encouraging expensive gifts from psychotherapy clients/patients

􀀴 Using “bait-and-switch” tactics to lure clients/patients into therapy with initial low

rates that are hiked after a few sessions

Violations of Standard 3.08 often occur in connection with other violations of

the Ethics Code. For example:

􀀴 Psychologists exploit the trust and vulnerability of individuals with whom they work

when they have sexual relationships with current clients/patients or students

(Standards 10.05, Sexual Intimacies With Current Therapy Clients/Patients, and 7.07,

Sexual Relationships With Students and Supervisees).

􀀴 Exploitation occurs when a psychologist accepts nonmonetary remuneration from

clients/patients, the value of which is substantially higher than the psychological services

rendered (Standard 6.05, Barter With Clients/Patients).

􀀴 Psychologists exploit patients with limited resources who they know will require longterm

treatment plans when they provide services until the patients’ money or insurance

runs out and then refer them to low-cost or free alternative treatments.

􀀴 It is exploitative to charge clients/patients for psychological assessments for

which the client/patient had not initially agreed to and that are unnecessary for

the agreed on goals of the psychological evaluation (Standard 6.04a, Fees and

Financial Arrangements).

􀀴 School psychologists exploit their students when, in their private practice, they provide

fee-for-service psychological testing to students who could receive these services

free of charge from the psychologist in the school district in which they work

(Standard 3.05a, Multiple Relationships; see also the Professional Conduct Manual

for School Psychology, National Association of School Psychologists, 2010, http://

www.nasponline.org/standards/ProfessionalCond.pdf).

Standard 3.08 does not prohibit psychologists from having a sliding-fee scale or

different payment plans for different types or amount of services, as long as the fee

practices are fairly and consistently applied.

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

122——PART II ENFORCEABLE STANDARDS

Recruitment for Research Participation

Institutional populations are particularly susceptible to research exploitation.

Prisoners and youth held for brief periods in detention centers, for example, are

highly vulnerable because of their restricted autonomy and liberty, often compounded

by their low socioeconomic status, poor education, and poor health

(Gostin, 2007). Incarcerated persons have few expectations regarding privacy protections

and may view research participation as a means of seeking favor with or

avoiding punishment from prison guards or detention officials. Inpatients in psychiatric

centers or nursing homes are also vulnerable to exploitive recruitment practices

that touch upon their fears that a participation refusal will result in denial of other

needed services. Investigators should ensure through adequate informed consent

procedures and discussion with institutional staff that research participation is not

coerced (Fisher, 2004; Fisher et al., 2002; Fisher & Vacanti-Shova, 2012; see also

Standards 8.02, Informed Consent to Research, and 8.06, Offering Inducements for

Research Participation).

3.09 Cooperation With Other Professionals

When indicated and professionally appropriate, psychologists cooperate with other professionals

in order to serve their clients/patients effectively and appropriately. (See also Standard 4.05,

Disclosures.)

Individuals who come to psychologists for assessment, counseling, or therapy

are often either receiving or in need of collateral medical, legal, educational, or

social services. Collaboration and consultation with, and referral to, other professionals

are thus often necessary to serve the best interests of clients/patients.

Standard 3.09 requires psychologists to cooperate with other professionals when it

is appropriate and will help serve the client/patient most effectively. For example:

􀀵 With permission and written authorization of the parent, a clinical child psychologist

spoke with a child’s teacher to help determine if behaviors suggestive of attention

deficit disorder exhibited at home and in the psychologist’s office were consistent

with the child’s classroom behavior.

􀀵 With consent from the parent, a school psychologist contacted a social worker who

was helping a student’s family apply for public assistance to help determine the availability

of collateral services (e.g., substance abuse counseling).

􀀵 A psychologist with prescribing privileges referred a patient to a physician for diagnosis

of physical symptoms thought by the patient to be the result of a psychological

disorder that was more suggestive of a medical condition.

In schools, hospitals, social service agencies, and other multidisciplinary settings,

a psychologist may have joint responsibilities with other professionals for the

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

Chapter 6 Standards on Human Relations——123

assessment or treatment of those with whom they work. In such settings, psychologists

should develop a clear agreement with the other professionals regarding overlapping

and distinct role responsibilities and how confidential information should

be handled in the best interests of the students or clients/patients. The nature of

these collaborative arrangements should be shared with the recipients of the services

or their legal guardians.

Implications of HIPAA

Psychologists who are covered entities under HIPAA should be familiar with

situations in which regulations requiring patients’ written authorization for

release of PHI apply to communications with other professionals (45 CFR 164.510,

164.512). They should also be aware of rules governing patients’ rights to know

when such disclosures have been made (45 CFR 164.520, Notice of Privacy

Practices, and 45 CFR 164.528, Accounting of Disclosures of Protected Health

Information).

3.10 Informed Consent

(a) When psychologists conduct research or provide assessment, therapy, counseling, or consulting

services in person or via electronic transmission or other forms of communication, they obtain

the informed consent of the individual or individuals using language that is reasonably understandable

to that person or persons except when conducting such activities without consent is

mandated by law or governmental regulation or as otherwise provided in this Ethics Code. (See

also Standards 8.02, Informed Consent to Research; 9.03, Informed Consent in Assessments; and

10.01, Informed Consent to Therapy.)

Informed consent is seen by many as the primary means of protecting the selfgoverning

and privacy rights of those with whom psychologists work (Principle E:

Respect for People’s Rights and Dignity). Required elements of informed consent for

specific areas of psychology are detailed in Standards 8.02, Informed Consent to

Research; 9.03, Informed Consent in Assessments; and 10.01, Informed Consent to

Therapy. The obligations described in Standard 3.10 apply to these other consent standards.

Language

In research, assessment, and therapy, psychologists must obtain informed consent

using language reasonably understandable by the person asked to consent. For

example, psychologists must use appropriate translations of consent information

for individuals for whom English is not a preferred language or who use sign language

or Braille. Psychologists should also adjust reading and language comprehension

levels of consent procedures to an individual’s developmental or educational

level or reading or learning disability.

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

124——PART II ENFORCEABLE STANDARDS

Culture

Individuals from recently immigrated or disadvantaged cultural communities

may lack familiarity with assessment, treatment or research procedures, and

terminology typically used in informed consent documents (Fisher, in press).

These individuals may also be unfamiliar with or distrust statements associated

with voluntary choice and other client/patient or research participant rights

described during informed consent. Standard 3.10 requires sensitivity to the

cultural dimensions of individuals’ understanding of and anticipated responses

to consent information and tailor informed consent language to such dimensions.

This may also require psychologists to include educational components

regarding the nature of and individual rights in agreeing to psychological services

or research participation. For individuals not proficient in English, written

informed consent information must be translated in a manner that considers

cultural differences in health care or scientific concepts that present challenges

in a word-for-word translation. When using interpreters to conduct informed

consent procedures, psychologists must follow the requirements of Standard 2.05,

Delegation of Work to Others, in ensuring their competence, training, and

supervision. Readers may also wish to refer to Hot Topic “Multicultural Ethical

Competence” in Chapter 5.

Consent via Electronic Transmission

Standard 3.10a requires that informed consent be obtained when research,

assessment, or therapy is conducted via electronic transmission such as the telephone

or the Internet. Psychologists need to take special steps to identify the language

and reading level of those from whom they obtain consent via electronic

media. In addition, psychologists conducting work via e-mail or other electronic

communications should take precautions to ensure that the individual who gave

consent is in fact the individual participating in the research or receiving the psychologist’s

services (i.e., use of a participant/client/patient password).

Exemptions

Some activities are exempt from the requirements of Standard 3.10. For example,

psychologists conducting court-ordered assessments or evaluating military

personnel may be prevented from obtaining consent by law or governmental regulation.

In addition, several standards in the Ethics Code detail conditions under

which informed consent may be waived (Standards 8.03, Informed Consent for

Recording Voices and Images in Research; 8.05, Dispensing With Informed Consent

for Research; and 8.07, Deception in Research). HIPAA also permits certain exemptions

from patient authorization requirements relevant to research and practice,

which are discussed in later chapters on standards for research, assessment, and

therapy (see also “A Word About HIPAA” in the Preface of this book).

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

Chapter 6 Standards on Human Relations——125

(b) For persons who are legally incapable of giving informed consent, psychologists nevertheless

(1) provide an appropriate explanation, (2) seek the individual’s assent, (3) consider such persons’

preferences and best interests, and (4) obtain appropriate permission from a legally authorized

person, if such substitute consent is permitted or required by law. When consent by a legally

authorized person is not permitted or required by law, psychologists take reasonable steps to

protect the individual’s rights and welfare.

Adults who have been declared legally incompetent and most children younger

than 18 years of age do not have the legal right to provide independent consent to

receive psychological services or participate in psychological research. In recognition

of these individuals’ rights as persons, Standard 3.10b requires that psychologists

obtain their affirmative agreement to participate in psychological activities after

providing them with an explanation of the nature and purpose of the activities and

their right to decline or withdraw from participation. The phrase “consider such

persons’ preferences and best interests” indicates that although in most instances,

psychologists respect a person’s right to dissent from participation in psychological

activities, this right can be superseded if failure to participate would deprive persons

of psychological services necessary to protect or promote their welfare.

For individuals who are legally incapable of giving informed consent, psychologists

must also obtain permission from a legally authorized person if such substitute

consent is permitted or required by law. Psychologists working with children

in the foster care system and in juvenile detention centers and those working with

institutionalized adults with identified cognitive or mental disorders leading to

decisional impairment must carefully determine who has legal responsibility for

substitute decision making. Psychologists should be aware that in some instances,

especially for children in foster care, legal guardianship may change over time.

Informed Consent in Research and Practice

Involving Children and Adolescents

In law and ethics, guardian permission is required to protect children from consent

vulnerabilities related to immature cognitive skills, lack of emotional preparedness

and experience in clinical or research settings, and actual or perceived

power differentials between children and adults (Fisher & Vacanti-Shova, 2012;

Koocher & Henderson Daniel, 2012). Despite these limitations, the landmark

“Convention on the Rights of the Child” (United Nations General Assembly, 1989)

established international recognition that children should have a voice in decisions

that affect their well-being. Out of respect for their developing autonomy, the APA

Ethics Code and federal regulations governing research (DHHS, 2009) require the

informed assent of children capable of providing assent. Psychologists working

with children should be familiar with the growing body of empirical data on the

development of children’s understanding of the nature of medical and mental

health treatment and research and with rights-related concepts such as confidentiality

and voluntary assent or dissent (Bruzzese & Fisher, 2003; Condie & Koocher, 2008;

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

126——PART II ENFORCEABLE STANDARDS

D. Daniels & Jenkins, 2010; Field & Behrman, 2004; Fisher, 2002a; Gibson, Stasiulis,

Gutfreund, McDonald, & Dade, 2011; Koelch et al., 2009; V. A. Miller, Drotar, &

Kodish, 2004; Unguru, 2011).

Need to Know: Ethically Appropriate

Child and Adolescent Assent Procedures

When creating the content and language of ethically appropriate assent procedures, psychologists

should be guided by the following (Chenneville, Sibille, & Bendell-Estroff, 2010;

Fisher & Vacanti-Shova, 2012; Masty & Fisher, 2008):

Empirical literature on children’s understanding of the nature and purpose of

mental health treatment or research, confidentiality protections and limitations,

and the voluntary nature of participation (Standard 2.01, Boundaries of

Competence)

Scientific and clinical knowledge of the relationship between specific pediatric

mental health disorders and the cognitive and emotional capacity to assent

(Standard 2.04, Bases for Scientific and Professional Judgments)

Individual evaluation, when relevant, of the child’s appreciation of his or her

mental health status and treatment needs, understanding of the risks and benefits

of assent or dissent, the information he or she may want or need to make an

informed assent decision, and whether an assessment of assent capacity is

required

The child’s experience with his or her own health care decision making and preference

for the degree of involvement the child wishes to have in the treatment or

research participation decision

Children should never be asked to assent or dissent to participation if their choice

will not be respected, that is, in situations in which assessment or intervention is

necessary to identify or alleviate a mental health problem (see also the discussion

of assent to pediatric clinical trials in Chapter 11)

Emancipated and Mature Minors

There are instances when guardian permission for treatment or research is not

required or possible for children younger than 18 years of age. For example, emancipated

minor is a legal status conferred on persons who have not yet attained the

age of legal competency (as defined by state law) but are entitled to treatment as if

they have such status by virtue of assuming adult responsibilities, such as selfsupport,

marriage, or procreation. Mature minor is someone who has not reached

adulthood (as defined by state law) but who, according to state law, may be treated

as an adult for certain purposes (e.g., consenting to treatment for venereal disease,

drug abuse, or emotional disorders). Psychologists working with children need to

be familiar with the definition of emancipated and mature minors in the specific

states in which they work. When a child is an emancipated or mature minor,

informed consent procedures should follow Standard 3.10a.

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

Chapter 6 Standards on Human Relations——127

Best Interests of the Child

The requirement for guardian permission may be inappropriate if there is serious

doubt whether the guardian’s interests adequately reflect the child’s interests

(e.g., cases of child abuse or neglect, genetic testing of a healthy child to assist in

understanding the disorder of a sibling) or cannot reasonably be obtained (e.g.,

treatment or research involving runaways). In such cases, the appointment of a

consent advocate can protect the child’s rights and welfare by verifying the minor’s

understanding of assent procedures, supporting the child’s preferences, ensuring

participation is voluntary, and monitoring reactions to psychological procedures.

Psychologists conducting research need to be familiar with federal regulations

regarding waiver of parental permission (45 CFR 46.408c) and have such waivers

approved by an IRB (Standard 8.01, Institutional Approval; Fisher, Hoagwood, &

Jensen, 1996; Fisher & Vacanti-Shova, 2012). Psychologists conducting therapy

need to be familiar with their state laws regarding provision of therapy to children

and adolescents without parental consent (Fisher, Hatashita-Wong, & Isman, 1999;

Koocher & Henderson Daniel, 2012).

Adults With Cognitive Impairments Who

Do Not Have Legal Guardians

There may be adults, such as those with Alzheimer’s disease or developmental

disabilities, who do not have a legal guardian but whose ability to fully understand

consent-relevant information is impaired (APA, 2012b). For example, clinical geropsychologists

frequently work with older persons with progressive dementia living

in nursing homes and assisted-living and residential care facilities where substitute

decision making is typically handled informally by family members or others. In

addition to obtaining consent from the individual, psychologists can seek additional

protections for the individual by encouraging a shared decision-making

process with or seeking additional permission from these informal caretakers

(Fisher, 1999, 2002b, 2003b; Fisher, Cea, Davidson, & Fried, 2006; see also the Hot

Topic, “Goodness-of-Fit Ethics for Informed Consent Involving Adults With

Impaired Decisional Capacity,” at the end of this chapter).

HIPAA Notice of Privacy Practices

HIPAA requires that if, under applicable law, a person has authority to act on

behalf of an individual who is an adult or minor in making decisions related to

health care, a covered entity must treat such a person (called a personal representative)

as the individual. Exceptions are permitted if there is reason to believe that the

patient has been abused or is endangered by the personal representative or that

treating the individual as a personal representative would not be in the best interests

of the client/patient (45 CFR 164.502g). This requirement refers to courtappointed

guardians or holders of relevant power of attorney of adults with

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

128——PART II ENFORCEABLE STANDARDS

impaired capacities, parents who are generally recognized as personal representatives

of their minor children, and individuals designated as a representative by the

patient. To comply with both Standard 3.10b and the HIPAA Notice of Privacy

Practices (see “A Word About HIPAA” in the Preface of this book), psychologists

should provide the Notice of Privacy Practices to both the individual’s legal guardian

or personal representative and the client/patient.

(c) When psychological services are court ordered or otherwise mandated, psychologists inform

the individual of the nature of the anticipated services, including whether the services are court

ordered or mandated and any limits of confidentiality, before proceeding.

When informed consent is prohibited by law or other governing authority, psychologists

must nonetheless respect an individual’s right to know the nature of

anticipated services, whether the services were court ordered or mandated by

another governing authority, and the limits of confidentiality before proceeding.

Military Psychologists

When regulations permit, military psychologists should inform active-duty personnel

of the psychologist’s duty to report information revealed during assessment

or therapy to appropriate military agencies violations of the Uniform Code of

Military Justice.

Court-Ordered Assessments

Psychologists conducting a court-ordered forensic assessment must inform the

individual tested (a) why the assessment is being conducted, (b) that the findings

may be entered into evidence in court, and (c) if known to the psychologist, the

extent to which the individual and his or her attorney will have access to the information.

The psychologist should not assume the role of legal adviser but can advise

the individual to speak with his or her attorney when a testee asks about potential

legal consequences of noncooperation.

(d) Psychologists appropriately document written or oral consent, permission, and assent. (See

also Standards 8.02, Informed Consent to Research; 9.03, Informed Consent in Assessments; and

10.01, Informed Consent to Therapy.)

Standard 3.10d requires psychologists conducting research or providing health

or forensic services to document that they have obtained consent or assent from an

individual and permission by a legal guardian or substitute decision maker. In most

instances, individuals will sign a consent, assent, or permission form. Sometimes,

oral consent is appropriate, such as when obtaining a young child’s assent, when

working with illiterate populations, when there is concern that confidentiality may

be at risk (i.e., in war-torn countries where consent documents may be confiscated

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

Chapter 6 Standards on Human Relations——129

by local authorities), or when a signature would risk identification in anonymous

surveys. In these situations, documentation can be provided by a note in the psychologist’s

records, or, in the case of anonymous, web-based or mail surveys, by the

participants’ checking a box to indicate that they have read the consent information

and agree to participate.

Implications of HIPAA

Appropriate documentation can also be related to legal requirements. For

example, HIPAA requires that all valid client/patient authorizations for the use and

disclosure of PHI be signed and dated by the individual or the individual’s personal

representative (45 CFR 164.508[c][1][vi]).

3.11 Psychological Services Delivered

To or Through Organizations

(a) Psychologists delivering services to or through organizations provide information beforehand

to clients and when appropriate those directly affected by the services about (1) the nature and

objectives of the services, (2) the intended recipients, (3) which of the individuals are clients,

(4) the relationship the psychologist will have with each person and the organization, (5) the

probable uses of services provided and information obtained, (6) who will have access to the

information, and (7) limits of confidentiality. As soon as feasible, they provide information about

the results and conclusions of such services to appropriate persons.

The informed consent procedures described in Standard 3.10, Informed Consent,

are often not appropriate or sufficient for consulting, program evaluation, job effectiveness,

or other psychological services delivered to or through organizations. In

such contexts, Standard 3.11 requires that organizational clients, employees, staff, or

others who may be involved in the psychologists’ activities be provided information

about (a) the nature, objectives, and intended recipients of the services; (b) which

individuals are clients and the relationship the psychologist will have with those

involved; (c) the probable uses of and who will have access to information gained;

and (d) the limits of confidentiality. Psychologists must provide results and conclusions

of the services to appropriate persons as early as is feasible.

􀀵 An industrial–organizational psychologist was hired to evaluate whether a company’s

flexible-shift policy had lowered employee absentee rates. In addition to a review of

employee records, the evaluation would include interviews with supervisors and employees

on the value and limits of the policy. The psychologist prepared a document for all

supervisors and employees explaining (a) the purpose of the evaluation, (b) the nature of

and reason for employee record review and the interviews, (c) that the evaluation would

be used to help the company decide if it should maintain or modify its current flexible-shift

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

130——PART II ENFORCEABLE STANDARDS

(b) If psychologists will be precluded by law or by organizational roles from providing such information

to particular individuals or groups, they so inform those individuals or groups at the outset of the service.

Standard 3.11b pertains to situations in which psychological services not requiring

informed consent are mandated by law or governmental regulations, and the law or

regulations restrict those affected by the services from receiving any aspect of the

information listed in Standard 3.11a.

policy, (d) that no one in the company would have access to the identities of the individuals

interviewed, and (e) that the results and conclusions would be presented to the

company’s board of directors in a manner that protected confidentiality.

􀀵 A psychologist was hired by a school district to observe teacher management of student

behavior during lunch and recess to help the district determine how many teachers were

required for such activities and whether additional staff training was needed for these

responsibilities. The psychologist held a meeting for all teaching staff who would be

involved in the observations. At the meeting, the psychologist explained why the school

district was conducting the research, how long it would last, the ways in which notes and

summaries of observations would be written to protect the identities of individual teachers,

that a detailed summary of findings would be presented to the school superintendent,

and that, with the district’s permission, teachers would receive a summary report.

􀀵 A psychologist providing court-ordered therapy to a convicted pedophile submitted a

report to the court regarding the therapy client’s attendance and responsiveness to treatment.

The therapist was prohibited from releasing the report to the client. At the beginning

of therapy, the psychologist had informed the client that such a report would be

written and that the client would not have access to the report through the psychologist.

􀀵 A company stipulated that the results of a personality inventory conducted as part of an

employee application and screening process would not be available to applicants.

Psychologists informed applicants about these restrictions prior to administering the tests.

􀀵 An inmate of a correctional institution was required to see the staff psychologist after

repeatedly engaging in disruptive and violent behaviors that were jeopardizing the

safety of the staff and other prisoners. The psychologist explained to the inmate that

in this situation, she was acting on the request of prison officials to help the inmate

control his behaviors. She also informed the inmate that she would be submitting

formal reports on the sessions that might be used by prison officials to determine if

the inmate would be assigned to a more restrictive facility.

Implications of HIPAA

Standard 3.11b may also apply to health care settings in which institutional

policy dictates that testing results are sent to another professional responsible for

interpreting and communicating the results to the client/patient. However, the

nature of such institutional policies may be changing in light of HIPAA regulations

providing greater client/patient access to PHI and control of disclosures of PHI.

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

Chapter 6 Standards on Human Relations——131

3.12 Interruption of Psychological Services

Unless otherwise covered by contract, psychologists make reasonable efforts to plan for facilitating

services in the event that psychological services are interrupted by factors such as the psychologist’s

illness, death, unavailability, relocation, or retirement or by the client’s/patient’s

relocation or financial limitations. (See also Standard 6.02c, Maintenance, Dissemination, and

Disposal of Confidential Records of Professional and Scientific Work.)

Planned and unplanned interruptions of psychological services often occur. For

example, a psychologist can leave a job at a mental health care facility for a new

position, take parental or family leave, interrupt services for a planned medical

procedure, or retire from private practice. Clients/patients may move out of state or

have a limited number of sessions covered by insurance.

When interruption of services can be anticipated, Standard 3.12 requires psychologists

to make reasonable efforts to ensure that needed service is continued. Such efforts

can include (a) discussing the interruption of services with the clients/patients and

responding to their concerns, (b) conducting pretermination counseling, (c)referring

the client/patient to another mental health practitioner, and, if feasible and clinically

appropriate, (d) working with the professional who will be responsible for the client’s/

patient’s case (see also Standard 10.10, Terminating Therapy).

􀀵 A psychologist providing Internet-mediated psychological services to clients in a distant

rural community included in her informed consent information the address of a

website she created providing continuously updated information on the names, credentials,

and contact information of local and electronically accessible backup professionals

available to assist clients if the psychologist was not immediately available

during an emergency.

Standard 3.12 also requires psychologists to prepare for unplanned interruptions

such as sudden illness or death. In most cases, it would suffice to have a

trusted professional colleague prepared to contact clients/patients if such a

situation arises. Pope and Vasquez (2007) recommend that psychologists create

a professional will, including directives on the person designated to assume

primary responsibility, backup personnel, coordinated planning, office security

and access, easy to locate schedule, avenues of communication, client records

and contact information, client notification, colleague notification, professional

liability coverage, attorney for professional issues, and billing records

and procedures.

The phrase “reasonable efforts” reflects awareness that some events are unpredictable

and even the best-laid plans may not be adequate when services are interrupted.

The phrase “unless otherwise covered by contract” recognizes that there may be

some instances when psychologists are prohibited by contract with a commercial or

health care organization from following through on plans to facilitate services.

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

132——PART II ENFORCEABLE STANDARDS

HOT TOPIC

Goodness-of-Fit Ethics for Informed Consent

to Research and Treatment Involving Adults

With Impaired Decisional Capacity

An outgrowth of the person-centered care movement has been growing recognition that adults with cognitive

disorders have rights, including the right to make decisions related to their own health care, independent living,

financial management, and participation in research (McKeown, Clarke, Ingleton, & Repper, 2010). The process of

obtaining informed consent presents unique ethical challenges for mental health treatment and research involving

adults with schizophrenia, developmental disabilities, Alzheimer’s disease, and other disorders characterized

by fluctuating, declining, or long-term impairments in decisional capacity. The heterogeneity of cognitive strengths

and deficits within each of these diagnostic groups means that judgments about each individual’s decisional

capacity cannot be based solely on his or her diagnosis (Kaup, Dunn, Saks, Jeste, & Palmer, 2011; Pierce, 2010).

Obtaining informed consent from these populations raises a fundamental ethical question: How can psychologists

balance their ethical obligation to respect the dignity and autonomy of persons with mental disorders to make

their own decisions with the obligation to ensure that ill-informed or incompetent choices do not jeopardize their

welfare or leave them open to exploitation (Fisher, 1999)?

Legal Status, Diagnostic Labels, and Consent Capacity

Some adults with serious mental disorders have been declared legally incompetent to consent. Removal of a

person’s legal status as a consenting adult does not, however, deprive him or her of the moral right to be

involved in treatment or research participation decisions. For these adults, APA Ethics Code Standard 3.10b

requires that psychologists obtain the appropriate permission from a legally authorized person and provide an

appropriate explanation to the prospective client/patient or research participant, consider such person’s preferences

and best interests, and seek the individual’s assent.

The implementation of ethically appropriate consent procedures is more complex for the many situations

in which individuals diagnosed with neurological or other mental health disorders retain the legal status of a

consenting adult, though their capacity for making informed, rational, and voluntary decisions may be compromised.

Each person with a serious mental disorder is unique. Sole reliance on a diagnostic label to determine

a client’s/patient’s capacity to make treatment or research participation decisions risks depriving persons

with mental disorders of equal opportunities for autonomous choice.

Fitting Consent Procedures

to Enhance Decisional Capacities and Protections

Thomas Grisso and Paul Appelbaum (Appelbaum & Grisso, 2001; Grisso & Appelbaum, 1998) have developed

the most well-known model of consent capacity for clinical research and treatment. Based on a psycho-legal

perspective, it consists of four increasingly complex consent components: choice, understanding, appreciation,

and reasoning. This model has given rise to several empirically validated instruments (Dunn, Nowrangi, Palmer,

Jeste, & Saks, 2006). However, in the case of Alzheimer’s Disease for example, practitioners do not agree on

the salience of these components for deciding a client’s/patient’s consent capacity (Volicer & Ganzine, 2003).

From an ethical perspective, assessing capacity is a necessary but insufficient basis for determining whether

an individual should be granted or deprived of the right to autonomously consent to treatment, assessment,

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

Chapter 6 Standards on Human Relations——133

or research. In her Goodness-of-Fit Ethics (GFE) for informed consent, Fisher argues that the burden of consent

capacity must be shared by psychologists and the individuals from whom consent is sought (Fisher, 2002a,

2002b, 2003). According to GFE, just and respectful informed consent processes require psychologists not only

to identify the consent strengths and vulnerabilities of the specific individuals or groups with whom they will

work, but also to take responsibility to create consent procedures that can minimize vulnerabilities, enhance

consent strengths, and provide consent supports when feasible (Fisher, 2005b; Fisher & Masty, 2006; Fisher &

Ragsdale, 2006; Fisher & Vacanti-Shova, 2012).

Goodness-of-Fit and Components of Consent

This section describes the four components of Grisso and Appelbaum’s model and discusses how the informed

consent process can be enhanced through goodness-of-fit procedures.

Choice

Evidencing a choice reflects the ability to actively indicate consent or dissent. For example, some adults

suffering from catatonia or Parkinson’s dementia may be unable to communicate a choice verbally or nonverbally.

While these individuals may understand some of the consent information presented and may have a

participation preference, their inability to communicate agreement or dissent will require stringent safeguards

against harmful or exploitative consent procedures.

In such settings, creating a goodness of fit between person and consent context often requires respectful

inclusion of a consent surrogate who has familiarity with the patient’s preference history. The proxy can help

ensure that the consent decision reflects, to the extent feasible, the patient’s attitudes, hopes, and concerns.

Once proxy consent has been obtained, respect for personhood and protection of individual welfare requires

psychologists to be alert to patient expressions of anxiety, fatigue, or distress that indicate an individual’s dissent

or desire to withdraw from participation.

Understanding

Understanding reflects comprehension of factual information about the nature, risks, and benefits of treatment

or research. When understanding is hampered by problems of attention or retention, psychologists can

incorporate consent enhancement techniques into their procedures such as incorporating pictorial representations

of treatment or research procedures, presenting information in brief segments, or using repetition. Person–

consent context fit also requires identifying which information is and is not critical to helping an individual

make an informed choice. For example, when seeking consent for a behavioral intervention for aggressive

disorders in a residence for adults with developmental disabilities, it may be important for clients to understand

the specific types of behaviors targeted (e.g., hitting other residents), the reward system that will be used

(e.g., points toward going to movies or other special activities), and who will be responsible for monitoring the

behavior, for example, residential staff (Cea & Fisher, 2003; Fisher et al., 2006). Although individuals should be

informed about the confidentiality and privacy of their records, psychologists should consider whether it is

important to limit the right to make autonomous decisions to only those individuals who understand details

of residential policies regarding the protection of residents’ health records, especially if the confidentiality

protections do not differ from those that are a natural and ongoing part of the residential experience.

Appreciation

Appreciation refers to the capacity to comprehend the personal consequences of consenting or dissenting

to treatment or research. For example, an adult with a dual diagnosis may understand that treatment will require

limiting aggressive behavior but not appreciate the difficulties he or she may have in adhering to the behavioral

FOR THE USE OF UNIVERSITY OF PHOENIX STUDENTS AND FACULTY ONLY.

NOT FOR DISTRIBUTION, SALE, OR REPRINTING.

ANY AND ALL UNAUTHORIZED USE IS STRICTLY PROHIBITED.

Copyright © 2013 by SAGE Publications, Inc.

134——PART II ENFORCEABLE STANDARDS

rules. An individual suffering from schizophrenia may understand that clinical research is testing treatment

effectiveness but may not appreciate that he or she has a disorder that requires treatment.

A sliding-scale approach based on the seriousness of personal consequences of the consent decision can

be helpful in evaluating the ethical weight that should be given to the client’s/patient’s or prospective research

participant’s capacity for appreciation. For example, understanding may be sufficient for consent decisions to

standard or experimental interventions that present minimal risk and are supplemental to current treatment

programs. On the other hand, appreciation may be essential when the treatment or experimental intervention

may expose the individual to the risk of serious side effects or offer an opportunity to receive needed services

not otherwise available.

Reasoning

Reasoning reflects the ability to weigh the risks and benefits of consent or dissent. For example, an adult

with schizophrenia with paranoid features may understand the nature of a treatment and appreciate its potential

for reducing his anxiety but may reason that the risks outweigh the potential benefits because the psychologist

offering the treatment is part of a government conspiracy to undermine his freedom. There is also

preliminary evidence that severe empathic deficits may confound reasoning about research participation even

when other cognitive skills are preserved (Supady, Voelkel, Witzel, Gubka, & Northoff, 2011). At the same time,

psychologists should be cautious about the legal consequences of erroneously assuming that paper-and-pencil

assessments of reasoning associated with decisional capacity are sufficient to evaluate “performative capacity”

defined as the ability of individuals to perform particular tasks (Appelbaum, 2009).

Asking individuals with questionable reasoning capacity to select a family member, friend, or other trusted

person to be present during an informed consent discussion can be empowering and avoid the risk of triggering a

legal competency review solely for the purposes of a single mental health treatment or research participation decision

(Fisher, 2002a; Fisher et al., 2006; Roeher Institute, 1996).

Consent and Empowerment

People with long-standing, declining, or transient disorders related to decisional capacities may be accustomed

to other people making decisions for them and may not understand or have experience applying the concept

of autonomy. In institutional contexts, individuals with mental disorders may fear disapproval from doctors or

residence supervisors or feel that they must be compliant in deference to the authority of the requesting psychologist.

Some may have little experience in exercising their rights or, if they are living in a community residence,

may be fearful of discontinuation of other services. Baeroe (2010) has described current approaches to

competency evaluations and surrogate consent in health care settings as arbitrary and inconsistently applied.

She questions whether the capacity decision of a single practitioner and the health care decision of a single

guardian are sufficient means of respecting patient autonomy, particularly for individuals with borderline

decision-making capacity. While recognizing the potential strain on institutional resources, she recommends a

“collective deliberation” for hospitalized patients with ambiguous capacity that would include the patient, his

or her guardian, health care workers with specific knowledge about the patient, and patient advocates.

To empower and respect the autonomy of patients or prospective research participants, psychologists can

study the nature of consent misconception among diagnostic groups and use this knowledge to develop brief

interventions to enhance consent capacity (Cea & Fisher, 2003; Fisher et al., 2006; Kaup et al., 2011; Mittal et al.,

2007). Modifying the consent setting to reduce the perception of power inequities, providing opportunities to

practice decision making, demonstrating that other services will not be compromised, and drawing on the

support of trusted family members and peers can strengthen the goodness of fit between person and consent

setting and ensure that informed consent is obtained within a context of justice and care.

 
Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

Quantative Design And Analysis Masters Course Assessment : Histograms And Descriptive Statistics homework help

Quantative Design And Analysis Masters Course Assessment : Histograms And Descriptive Statistics homework help

For this three-part assessment, you will create and interpret histograms and compute descriptive statistics for given variables; analyze the goals of data screening; and generate scores for variables, analyze types of error, and analyze cases to either reject or not reject a null hypothesis. You will use SPSS software and several Capella course files to complete this assessment.

A solid understanding of descriptive statistics is foundational to grasping the concepts presented in inferential statistics. This assessment measures your understanding of key elements of descriptive statistics.

SHOW LESS

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

  • Competency 1: Analyze the computation, application, strengths, and limitations of various statistical tests.
    • Analyze the strengths and limitations of examining a distribution of scores with a histogram.
    • Analyze the relevant data from the computation, interpretation, and application of z-scores.
    • Analyze real-world application of Type I and Type II errors and the research decisions that influence the relative risk of each.
  • Competency 2: Analyze the decision-making process of data analysis.
    • Analyze meaningful versus meaningless variables reported in descriptive statistics.
    • Apply the logic of null hypothesis testing to cases.
  • Competency 4: Interpret the results of statistical analyses.
    • Interpret histogram results, including concepts of skew, kurtosis, outliers, symmetry, and modality.
    • Interpret descriptive statistics for meaningful variables.
  • Competency 5: Apply a statistical program’s procedure to data.
    • Apply the appropriate SPSS procedures for creating histograms to generate relevant output.
    • Apply the appropriate SPSS procedure for generating descriptive statistics to generate relevant output.
    • Apply the appropriate SPSS procedures for creating z-scores and descriptive statistics to generate relevant output.
  • Competency 7: Communicate in a manner that is scholarly, professional, and consistent with expectations for members of the identified field of study.
    • Communicate in a manner that is scholarly, professional, and consistent with expectations for members of the identified field of study.

     

Read Assessment 1 Context [DOC] for important information on the following topics:

SHOW LESS

  • The standard normal distribution and scores.
  • Hypothesis testing.
  • Null and alternative hypotheses.
  • Type I and Type II errors.
  • Probability values and the null hypothesis.

 

APA Resources

Because this is a psychology course, you need to format this assessment according to APA guidelines. Additional resources about APA can be found in the Research Resources in the courseroom navigation menu. Use the resources to guide your work.

  • American Psychological Association. (2010). Publication manual of the American Psychological Association (6th ed.). Washington, DC: Author.

Required Resources

The following resources are required to complete the assessment.

SPSS Software

The following statistical analysis software is required to complete your assessments in this course:

  • IBM SPSS Statistics Standard or Premium GradPack (recent version for Windows or Mac).
    • As a Capella learner, you have access to the more robust IBM SPSS Statistics Premium GradPack arranged at an academic discount through a contracted vendor.
    • Please refer to the Statistical Software page on Campus for general information on SPSS software, including the most recent version made available to Capella learners.
Data Set and Software Procedure
  • Data Set Instructions [DOCX].
    • These instructions explain how to access the data needed for this assessment.
  • grades.sav.
    • This file contains the data set used with SPSS to complete the assessment.
Assessment Template and Output Instructions

Preparation

This assessment has three parts, each of which is described below. Submit all three parts as Word documents.

Note: All the course documents you will need for the assessment are linked in the Resources section.

Read Assessment 1 Context to learn about the concepts used in this assessment.

This assessment uses the grades.sav file, found in the Resources for this assessment.

The fictional data in the grades.sav file represent a teacher’s recording of student demographics and performance on quizzes and a final exam across three sections of the course. Each section consists of about 35 students (N = 105).

There are 21 variables in grades.sav. To prepare for this assessment, complete the following:

  • Open your grades.sav file and navigate to the “Variable View” tab.
  • Read the Data Set Instructions, and make sure you have the correct Values and Scales of Measurement assigned.

Part 1: Histograms and Descriptive Statistics

Your first IBM SSPS assessment includes two sections:

  • Create two histograms and provide interpretations.
  • Calculate measures of central tendency and dispersion and provide interpretations.
Key Details and Instructions
  • Submit your assessment as an attached Word document.
  • Begin your assessment by creating a properly formatted APA title page. Include a reference list at the end of the document if necessary. On page 2, begin Section 1.
  • Organize the narrative report with your SPSS output charts and tables integrated along with your responses to the specific requirements listed for that assessment. (See the Copy/Export Output Instructions in the Resources for instructions on how to do this.)
  • Label all tables and graphs in a manner consistent with APA style and formatting guidelines. Citations, if needed, should be included in the text as well as a reference section at the end of the report.
  • For additional help in completing this assessment, refer to IBM SPSS Step-By-Step Instructions: Histograms and Descriptive Statistics, linked in the Resources.
Section 1: Histograms and Visual Interpretation

Section 1 will include one histogram of “total” scores for all the males in the data set, and one histogram of “total” scores for all the females in the data set.

Create two histograms using the total and gender variables in your grades.sav data set:

  • A histogram for male students.
  • A histogram for female students.

Below the histograms, provide an interpretation based on your visual inspection. Correctly use all of the following terms in your discussion:

  • Skew.
  • Kurtosis.
  • Outlier.
  • Symmetry.
  • Modality.

Comment on any differences between males and females regarding their total scores. Analyze the strengths and limitations of visually interpreting histograms.

Section 2: Calculate and Interpret Measures of Central Tendency and Dispersion

Using the grades.sav file, compute descriptive statistics, including mean, standard deviation, skewness, and kurtosis for the following variables:

  • id.
  • gender.
  • ethnicity.
  • gpa.
  • quiz3.
  • total.

Below the Descriptives table, complete the following:

  • Indicate which variable or variables are meaningless to interpret in terms of mean, standard deviation, skewness, and kurtosis. Justify your decision.
  • Next, indicate which variable or variables are meaningful to interpret. Justify your decision. For meaningful variables, specify any variables that are in the ideal range for both skewness and kurtosis.
  • Specify any variables that are acceptable but not excellent.
  • Specify any variables that are unacceptable. Explain your decisions.
  • For all meaningful variables, report and interpret the descriptive statistics (mean, standard deviation, skewness, and kurtosis).

Part 2: Data Screening

For this part of the assessment, respond to the following questions:

What are the goals of data screening? How can you identify and remedy the following?

  • Errors in data entry.
  • Outliers.
  • Missing data.

Part 3: Scores, Type I and II Error, Null Hypothesis Testing

This IBM SPSS assessment includes three sections:

  • Generate scores for a variable in grades.sav and report/interpret them.
  • Analyze cases of Type I and Type II error.
  • Analyze cases to either reject or not reject a null hypothesis.

The format of this assessment should be narrative with supporting statistical output (table and graphs) integrated into the narrative in the appropriate place (not all at the end of the document). See the Copy/Export Output Instructions for instructions on how to do this.

Download the Scores, Type I and Type II Error, Null Hypothesis Testing Answer Template from the Required Resources, and use the template to complete the following sections:

  • Section 1: Scores in SPSS.
  • Section 2: Case Studies of Type I and Type II Error.
  • Section 3: Case Studies of Null Hypothesis Testing.
 
Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

Multicontextual Life Cycle homework help

Multicontextual Life Cycle homework help

In this assignment, you will explain the Multicontextual Life Cycle Framework as well as completing a self-genogram of your family system. Complete the “Multicontextual Life Cycle Framework” worksheet. This assignment assesses the following programmatic competency: 6.1: Analyze the forms and functions of families at different developmental stages.

In order to analyze a family system, it is important to understand the multisystem structure. This assignment will help you learn this concept.

First, create a self-genogram of your family system, looking at it through the multisystem lens. Complete your family’s genogram and discuss your family system in terms of the family life cycle.

The genogram can be handwritten and scanned, done as a PDF, or done using Word tools to ensure it can be uploaded to LoudCloud. You can also go to the following site or another similar genogram site of your choice to download the GenPro software.

http://www.genopro.com/

Use the different phases listed in Figure 1.5 of the textbook to look at both the emotional process of transition and the second order tasks (If you have a large family, pick six to eight key individuals including yourself to discuss). Relate this to what your family members are going through in their lives presently (you can include key moments of the past – someone passing away, going through cancer treatment, miscarriage, etc.):

  • All family members
  • Include ages (if known), marriages, divorces, deaths
  • Substance use identified
  • Mental illness identified
  • All relationship dynamics

MHW-522: Multicontextual Life Cycle Framework Assignment

In order to understand the changes in the life span/developmental theory within the last few decades, complete the tables, explaining the stages and phases of the family life cycle including the second order tasks.

Use the textbook, assigned readings, and two to four additional scholarly sources to defend your answers.

Family Life Cycle Stage Key Principles of Emotional Process of Transition Second-Order Changes Required to Proceed Developmentally
Young Children    
Adolescents    
Young Adults    
Middle Adults    
Older Adults    

 

Next, complete the following table that focuses on Family Life Cycle Phases.

Family Life Cycle Phase Key Principles of Emotional Process of Transition Second-Order Changes Required to Proceed Developmentally
Emerging Young Adults    
Newly Married Couples    
Families with Young Children    
Families with Adolescents    
Middle Aged families dealing with retirement    
Families dealing End of Life Issues    

 

Reflection Questions:

After completing the tables, explain the possible cultural factors that play a major role in how families transition through the life cycle. (150-200 words)

 

Select two stages from the tables. Explain how society has influenced the changes in the life span/developmental theory of the selected stages. (200-250 words)

 

Select two of the life phases. For the selected phases, include feminist theory, patriarchy/gender expectations, social class, and economically fragile families in explaining the changes in these phases over the decades. (300-400 words)

 

 

References:

© 2016. Grand Canyon University. All Rights Reserved.

 

© 2016. Grand Canyon University. All Rights Reserved.

 
Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

Psychology Reliability homework help

Psychology Reliability homework help

Modules Chapter 5 wk2 p655

 

C H A P T E R  5

Reliability

In everyday conversation, reliability is a synonym for dependability or consistency. We speak of the train that is so reliable you can set your watch by it. If we’re lucky, we have a reliable friend who is always there for us in a time of need.

Broadly speaking, in the language of psychometrics reliability refers to consistency in measurement. And whereas in everyday conversation reliability always connotes something positive, in the psychometric sense it really only refers to something that is consistent—not necessarily consistently good or bad, but simply consistent.

It is important for us, as users of tests and consumers of information about tests, to know how reliable tests and other measurement procedures are. But reliability is not an all-or-none matter. A test may be reliable in one context and unreliable in another. There are different types and degrees of reliability. A  reliability coefficient  is an index of reliability, a proportion that indicates the ratio between the true score variance on a test and the total variance. In this chapter, we explore different kinds of reliability coefficients, including those for measuring test-retest reliability, alternate-forms reliability, split-half reliability, and inter-scorer reliability.

The Concept of Reliability

Recall from our discussion of classical test theory that a score on an ability test is presumed to reflect not only the testtaker’s true score on the ability being measured but also error.1 In its broadest sense, error refers to the component of the observed test score that does not have to do with the testtaker’s ability. If we use X to represent an observed score, T to represent a true score, and E to represent error, then the fact that an observed score equals the true score plus error may be expressed as follows:

 

A statistic useful in describing sources of test score variability is the  variance  (σ2)—the standard deviation squared. This statistic is useful because it can be broken into components. Page 142Variance from true differences is  true variance , and variance from irrelevant, random sources is  error variance . If σ2 represents the total variance, the true variance, and the error variance, then the relationship of the variances can be expressed as

 

In this equation, the total variance in an observed distribution of test scores (σ2) equals the sum of the true variance  plus the error variance . The term  reliability  refers to the proportion of the total variance attributed to true variance. The greater the proportion of the total variance attributed to true variance, the more reliable the test. Because true differences are assumed to be stable, they are presumed to yield consistent scores on repeated administrations of the same test as well as on equivalent forms of tests. Because error variance may increase or decrease a test score by varying amounts, consistency of the test score—and thus the reliability—can be affected.

In general, the term  measurement error  refers to, collectively, all of the factors associated with the process of measuring some variable, other than the variable being measured. To illustrate, consider an English-language test on the subject of 12th-grade algebra being administered, in English, to a sample of 12-grade students, newly arrived to the United States from China. The students in the sample are all known to be “whiz kids” in algebra. Yet for some reason, all of the students receive failing grades on the test. Do these failures indicate that these students really are not “whiz kids” at all? Possibly. But a researcher looking for answers regarding this outcome would do well to evaluate the English-language skills of the students. Perhaps this group of students did not do well on the algebra test because they could neither read nor understand what was required of them. In such an instance, the fact that the test was written and administered in English could have contributed in large part to the measurement error in this evaluation. Stated another way, although the test was designed to evaluate one variable (knowledge of algebra), scores on it may have been more reflective of another variable (knowledge of and proficiency in English language). This source of measurement error (the fact that the test was written and administered in English) could have been eliminated by translating the test and administering it in the language of the testtakers.

Measurement error, much like error in general, can be categorized as being either systematic or random.  Random error  is a source of error in measuring a targeted variable caused by unpredictable fluctuations and inconsistencies of other variables in the measurement process. Sometimes referred to as “noise,” this source of error fluctuates from one testing situation to another with no discernible pattern that would systematically raise or lower scores. Examples of random error that could conceivably affect test scores range from unanticipated events happening in the immediate vicinity of the test environment (such as a lightning strike or a spontaneous “occupy the university” rally), to unanticipated physical events happening within the testtaker (such as a sudden and unexpected surge in the testtaker’s blood sugar or blood pressure).

JUST THINK . . .

What might be a source of random error inherent in all the tests an assessor administers in his or her private office?

In contrast to random error,  systematic error  refers to a source of error in measuring a variable that is typically constant or proportionate to what is presumed to be the true value of the variable being measured. For example, a 12-inch ruler may be found to be, in actuality, a tenth of one inch longer than 12 inches. All of the 12-inch measurements previously taken with that ruler were systematically off by one-tenth of an inch; that is, anything measured to be exactly 12 inches with that ruler was, in reality, 12 and one-tenth inches. In this example, it is the measuring instrument itself that has been found to be a source of systematic error. Once a systematic error becomes known, it becomes predictable—as well as fixable. Note also that a systematic source of error does not affect score consistency. So, for example, suppose a measuring instrument such as the official weight scale used on The Biggest Loser television Page 143program consistently underweighed by 5 pounds everyone who stepped on it. Regardless of this (systematic) error, the relative standings of all of the contestants weighed on that scale would remain unchanged. A scale underweighing all contestants by 5 pounds simply amounts to a constant being subtracted from every “score.” Although weighing contestants on such a scale would not yield a true (or valid) weight, such a systematic error source would not change the variability of the distribution or affect the measured reliability of the instrument. In the end, the individual crowned “the biggest loser” would indeed be the contestant who lost the most weight—it’s just that he or she would actually weigh 5 pounds more than the weight measured by the show’s official scale. Now moving from the realm of reality television back to the realm of psychological testing and assessment, let’s take a closer look at the source of some error variance commonly encountered during testing and assessment.

JUST THINK . . .

What might be a source of systematic error inherent in all the tests an assessor administers in his or her private office?

Sources of Error Variance

Sources of error variance include test construction, administration, scoring, and/or interpretation.

Test construction

One source of variance during test construction is  item sampling  or  content sampling , terms that refer to variation among items within a test as well as to variation among items between tests. Consider two or more tests designed to measure a specific skill, personality attribute, or body of knowledge. Differences are sure to be found in the way the items are worded and in the exact content sampled. Each of us has probably walked into an achievement test setting thinking “I hope they ask this question” or “I hope they don’t ask that question.” If the only questions on the examination were the ones we hoped would be asked, we might achieve a higher score on that test than on another test purporting to measure the same thing. The higher score would be due to the specific content sampled, the way the items were worded, and so on. The extent to which a testtaker’s score is affected by the content sampled on a test and by the way the content is sampled (that is, the way in which the item is constructed) is a source of error variance. From the perspective of a test creator, a challenge in test development is to maximize the proportion of the total variance that is true variance and to minimize the proportion of the total variance that is error variance.

Test administration

Sources of error variance that occur during test administration may influence the testtaker’s attention or motivation. The testtaker’s reactions to those influences are the source of one kind of error variance. Examples of untoward influences during administration of a test include factors related to the test environment: room temperature, level of lighting, and amount of ventilation and noise, for instance. A relentless fly may develop a tenacious attraction to an examinee’s face. A wad of gum on the seat of the chair may make itself known only after the testtaker sits down on it. Other environment-related variables include the instrument used to enter responses and even the writing surface on which responses are entered. A pencil with a dull or broken point can make it difficult to blacken the little grids. The writing surface on a school desk may be riddled with heart carvings, the legacy of past years’ students who felt compelled to express their eternal devotion to someone now long forgotten. External to the test environment in a global sense, the events of the day may also serve as a source of error. So, for example, test results may vary depending upon whether the testtaker’s country is at war or at peace (Gil et al., 2016). A variable of interest when evaluating a patient’s general level of suspiciousness or fear is the patient’s home neighborhood and lifestyle. Especially in patients who live in and must cope daily with an unsafe neighborhood, Page 144what is actually adaptive fear and suspiciousness can be misinterpreted by an interviewer as psychotic paranoia (Wilson et al., 2016).

Other potential sources of error variance during test administration are testtaker variables. Pressing emotional problems, physical discomfort, lack of sleep, and the effects of drugs or medication can all be sources of error variance. Formal learning experiences, casual life experiences, therapy, illness, and changes in mood or mental state are other potential sources of testtaker-related error variance. It is even conceivable that significant changes in the testtaker’s body weight could be a source of error variance. Weight gain and obesity are associated with a rise in fasting glucose level—which in turn is associated with cognitive impairment. In one study that measured performance on a cognitive task, subjects with high fasting glucose levels made nearly twice as many errors as subjects whose fasting glucose level was in the normal range (Hawkins et al., 2016).

Examiner-related variables are potential sources of error variance. The examiner’s physical appearance and demeanor—even the presence or absence of an examiner—are some factors for consideration here. Some examiners in some testing situations might knowingly or unwittingly depart from the procedure prescribed for a particular test. On an oral examination, some examiners may unwittingly provide clues by emphasizing key words as they pose questions. They might convey information about the correctness of a response through head nodding, eye movements, or other nonverbal gestures. In the course of an interview to evaluate a patient’s suicidal risk, highly religious clinicians may be more inclined than their moderately religious counterparts to conclude that such risk exists (Berman et al., 2015). Clearly, the level of professionalism exhibited by examiners is a source of error variance.

Test scoring and interpretation

In many tests, the advent of computer scoring and a growing reliance on objective, computer-scorable items have virtually eliminated error variance caused by scorer differences. However, not all tests can be scored from grids blackened by no. 2 pencils. Individually administered intelligence tests, some tests of personality, tests of creativity, various behavioral measures, essay tests, portfolio assessment, situational behavior tests, and countless other tools of assessment still require scoring by trained personnel.

Manuals for individual intelligence tests tend to be very explicit about scoring criteria, lest examinees’ measured intelligence vary as a function of who is doing the testing and scoring. In some tests of personality, examinees are asked to supply open-ended responses to stimuli such as pictures, words, sentences, and inkblots, and it is the examiner who must then quantify or qualitatively evaluate responses. In one test of creativity, examinees might be given the task of creating as many things as they can out of a set of blocks. Here, it is the examiner’s task to determine which block constructions will be awarded credit and which will not. For a behavioral measure of social skills in an inpatient psychiatric service, the scorers or raters might be asked to rate patients with respect to the variable “social relatedness.” Such a behavioral measure might require the rater to check yes or no to items like Patient says “Good morning” to at least two staff members.

JUST THINK . . .

Can you conceive of a test item on a rating scale requiring human judgment that all raters will score the same 100% of the time?

Scorers and scoring systems are potential sources of error variance. A test may employ objective-type items amenable to computer scoring of well-documented reliability. Yet even then, a technical glitch might contaminate the data. If subjectivity is involved in scoring, then the scorer (or rater) can be a source of error variance. Indeed, despite rigorous scoring criteria set forth in many of the better-known tests of intelligence, examiner/scorers occasionally still are confronted by situations where an examinee’s response lies in a gray area. The element of subjectivity in scoring may be much greater in the administration of certain nonobjective-type personality tests, tests of creativity (such as the block test just described), and certain academic tests (such as essay examinations). Subjectivity in scoring can even enter into Page 145behavioral assessment. Consider the case of two behavior observers given the task of rating one psychiatric inpatient on the variable of “social relatedness.” On an item that asks simply whether two staff members were greeted in the morning, one rater might judge the patient’s eye contact and mumbling of something to two staff members to qualify as a yes response. The other observer might feel strongly that a no response to the item is appropriate. Such problems in scoring agreement can be addressed through rigorous training designed to make the consistency—or reliability—of various scorers as nearly perfect as can be.

Other sources of error

Surveys and polls are two tools of assessment commonly used by researchers who study public opinion. In the political arena, for example, researchers trying to predict who will win an election may sample opinions from representative voters and then draw conclusions based on their data. However, in the “fine print” of those conclusions is usually a disclaimer that the conclusions may be off by plus or minus a certain percent. This fine print is a reference to the margin of error the researchers estimate to exist in their study. The error in such research may be a result of sampling error—the extent to which the population of voters in the study actually was representative of voters in the election. The researchers may not have gotten it right with respect to demographics, political party affiliation, or other factors related to the population of voters. Alternatively, the researchers may have gotten such factors right but simply did not include enough people in their sample to draw the conclusions that they did. This brings us to another type of error, called methodological error. So, for example, the interviewers may not have been trained properly, the wording in the questionnaire may have been ambiguous, or the items may have somehow been biased to favor one or another of the candidates.

Certain types of assessment situations lend themselves to particular varieties of systematic and nonsystematic error. For example, consider assessing the extent of agreement between partners regarding the quality and quantity of physical and psychological abuse in their relationship. As Moffitt et al. (1997) observed, “Because partner abuse usually occurs in private, there are only two persons who ‘really’ know what goes on behind closed doors: the two members of the couple” (p. 47). Potential sources of nonsystematic error in such an assessment situation include forgetting, failing to notice abusive behavior, and misunderstanding instructions regarding reporting. A number of studies (O’Leary & Arias, 1988; Riggs et al., 1989; Straus, 1979) have suggested that underreporting or overreporting of perpetration of abuse also may contribute to systematic error. Females, for example, may underreport abuse because of fear, shame, or social desirability factors and overreport abuse if they are seeking help. Males may underreport abuse because of embarrassment and social desirability factors and overreport abuse if they are attempting to justify the report.

Just as the amount of abuse one partner suffers at the hands of the other may never be known, so the amount of test variance that is true relative to error may never be known. A so-called true score, as Stanley (1971, p. 361) put it, is “not the ultimate fact in the book of the recording angel.” Further, the utility of the methods used for estimating true versus error variance is a hotly debated matter (see Collins, 1996; Humphreys, 1996; Williams & Zimmerman, 1996a, 1996b). Let’s take a closer look at such estimates and how they are derived.

Reliability Estimates

Test-Retest Reliability Estimates

A ruler made from the highest-quality steel can be a very reliable instrument of measurement. Every time you measure something that is exactly 12 inches long, for example, your ruler will tell you that what you are measuring is exactly 12 inches long. The reliability of this instrument Page 146of measurement may also be said to be stable over time. Whether you measure the 12 inches today, tomorrow, or next year, the ruler is still going to measure 12 inches as 12 inches. By contrast, a ruler constructed of putty might be a very unreliable instrument of measurement. One minute it could measure some known 12-inch standard as 12 inches, the next minute it could measure it as 14 inches, and a week later it could measure it as 18 inches. One way of estimating the reliability of a measuring instrument is by using the same instrument to measure the same thing at two points in time. In psychometric parlance, this approach to reliability evaluation is called the test-retest method, and the result of such an evaluation is an estimate of test-retest reliability.

Test-retest reliability  is an estimate of reliability obtained by correlating pairs of scores from the same people on two different administrations of the same test. The test-retest measure is appropriate when evaluating the reliability of a test that purports to measure something that is relatively stable over time, such as a personality trait. If the characteristic being measured is assumed to fluctuate over time, then there would be little sense in assessing the reliability of the test using the test-retest method.

As time passes, people change. For example, people may learn new things, forget some things, and acquire new skills. It is generally the case (although there are exceptions) that, as the time interval between administrations of the same test increases, the correlation between the scores obtained on each testing decreases. The passage of time can be a source of error variance. The longer the time that passes, the greater the likelihood that the reliability coefficient will be lower. When the interval between testing is greater than six months, the estimate of test-retest reliability is often referred to as the  coefficient of stability .

An estimate of test-retest reliability from a math test might be low if the testtakers took a math tutorial before the second test was administered. An estimate of test-retest reliability from a personality profile might be low if the testtaker suffered some emotional trauma or received counseling during the intervening period. A low estimate of test-retest reliability might be found even when the interval between testings is relatively brief. This may well be the case when the testings occur during a time of great developmental change with respect to the variables they are designed to assess. An evaluation of a test-retest reliability coefficient must therefore extend beyond the magnitude of the obtained coefficient. If we are to come to proper conclusions about the reliability of the measuring instrument, evaluation of a test-retest reliability estimate must extend to a consideration of possible intervening factors between test administrations.

An estimate of test-retest reliability may be most appropriate in gauging the reliability of tests that employ outcome measures such as reaction time or perceptual judgments (including discriminations of brightness, loudness, or taste). However, even in measuring variables such as these, and even when the time period between the two administrations of the test is relatively small, various factors (such as experience, practice, memory, fatigue, and motivation) may intervene and confound an obtained measure of reliability.2

Taking a broader perspective, psychological science, and science in general, demands that the measurements obtained by one experimenter be replicable by other experimenters using the same instruments of measurement and following the same procedures. However, as observed in this chapter’s  Close-Up , a replicability problem of epic proportions appears to be brewing.Page 147

CLOSE-UP

Psychology’s Replicability Crisis*

In the mid-2000s, academic scientists became concerned that science was not being performed rigorously enough to prevent spurious results from reaching consensus within the scientific community. In other words, they worried that scientific findings, although peer-reviewed and published, were not replicable by independent parties. Since that time, hundreds of researchers have endeavored to determine if there is really a problem, and if there is, how to curb it. In 2015, a group of researchers called the Open Science Collaboration attempted to redo 100 psychology studies that had already been peer-reviewed and published in leading journals (Open Science Collaboration, 2015). Their results, published in the journal Science, indicated that, depending on the criteria used, only 40–60% of replications found the same results as the original studies. This low replication rate helped confirm that science indeed had a problem with replicability, the seriousness of which is reflected in the term replicability crisis.

Why and how did this crisis of replicability emerge? Here it will be argued that the major causal factors are (1) a general lack of published replication attempts in the professional literature, (2) editorial preferences for positive over negative findings, and (3) questionable research practices on the part of authors of published studies. Let’s consider each of these factors.

Lack of Published Replication Attempts

Journals have long preferred to publish novel results instead of replications of previous work. In fact, a recent study found that only 1.07% of the published psychological scientific literature sought to directly replicate previous work (Makel et al., 2012). Academic scientists, who depend on publication in order to progress in their careers, respond to this bias by focusing their research on unexplored phenomena instead of replications. The implications for science are dire. Replication by independent parties provides for confidence in a finding, reducing the likelihood of experimenter bias and statistical anomaly. Indeed, had scientists been as focused on replication as they were on hunting down novel results, the field would likely not be in crisis now.

Editorial Preference for Positive over Negative Findings

Journals prefer positive over negative findings. “Positive” in this context does not refer to how upbeat, beneficial, or heart-warming the study is. Rather, positive refers to whether the study concluded that an experimental effect existed. Stated another way, and drawing on your recall from that class you took in experimental methods, positive findings typically entail a rejection of the null hypothesis. In essence, from the perspective of most journals, rejecting the null hypothesis as a result of a research study is a newsworthy event. By contrast, accepting the null hypothesis might just amount to “old news.”

The fact that journals are more apt to publish positive rather than negative studies has consequences in terms of the types of studies that even get submitted for publication. Studies submitted for publication typically report the existence of an effect rather than the absence of one. The vast majority of studies that actually get published also report the existence of an effect. Those studies designed to disconfirm reports of published effects are few-and-far-between to begin with, and may not be deemed publishable even when they are conducted and submitted to a journal for review. The net result is that scientists, policy-makers, judges, and anyone else who has occasion to rely on published research may have a difficult time determining the actual strength and robustness of a reported finding.

Questionable Research Practices (QRPs)

In this admittedly nonexhaustive review of factors contributing to the replicability crisis, the third factor is QRPs. Included here are questionable scientific practices that do not rise to the level of fraud but still introduce error into bodies of scientific evidence. For example, a recent survey of psychological scientists found that nearly 60% of the respondents reported that they decided to collect more data after peeking to see if their already-collected data had reached statistical significance (John et al., 2012). While this procedure may seem relatively benign, it is not. Imagine you are trying to determine if a nickel is fair, or weighted toward heads. Rather than establishing the number flips you plan on performing prior to your “test,” you just start flipping and from time-to-time check how many times the coin has come up heads. After a run of five heads, you notice that your weighted-coin hypothesis is looking strong and decide to stop flipping. The nonindependence between the decision to collect data and the data themselves introduces bias. Over the course of many studies, such practices can seriously undermine a body of research.

There are many other sorts of QRPs. For example, one variety entails the researcher failing to report all of the research undertaken in a research program, and then Page 148selectively only reporting the studies that confirm a particular hypothesis. With only the published study in hand, and without access to the researchers’ records, it would be difficult if not impossible for the research consumer to discern important milestones in the chronology of the research (such as what studies were conducted in what sequence, and what measurements were taken).

One proposed remedy for such QRPs is preregistration (Eich, 2014). Preregistration involves publicly committing to a set of procedures prior to carrying out a study. Using such a procedure, there can be no doubt as to the number of observations planned, and the number of measures anticipated. In fact, there are now several websites that allow researchers to preregister their research plans. It is also increasingly common for academic journals to demand preregistration (or at least a good explanation for why the study wasn’t preregistered). Alternatively, some journals award special recognition to studies that were preregistered so that readers can have more confidence in the replicability of the reported findings.

Lessons Learned from the Replicability Crisis

The replicability crisis represents an important learning opportunity for scientists and students. Prior to such replicability issues coming to light, it was typically assumed that science would simply self-correct over the long run. This means that at some point in time, the nonreplicable study would be exposed as such, and the scientific record would somehow be straightened out. Of course, while some self-correction does occur, it occurs neither fast enough nor often enough, nor in sufficient magnitude. The stark reality is that unreliable findings that reach general acceptance can stay in place for decades before they are eventually disconfirmed. And even when such long-standing findings are proven incorrect, there is no mechanism in place to alert other scientists and the public of this fact.

Traditionally, science has only been admitted into courtrooms if an expert attests that the science has reached “general acceptance” in the scientific community from which it comes. However, in the wake of science’s replicability crisis, it is not at all uncommon for findings to meet this general acceptance standard. Sadly, the standard may be met even if the findings from the subject study are questionable at best, or downright inaccurate at worst. Fortunately, another legal test has been created in recent years (Chin, 2014). In this test, judges are asked to play a gatekeeper role and only admit scientific evidence if it has been properly tested, has a sufficiently low error rate, and has been peer-reviewed and published. In this latter test, judges can ask more sensible questions, such as whether the study has been replicated and if the testing was done using a safeguard like preregistration.

Conclusion

Spurred by the recognition of a crisis of replicability, science is moving to right from both past and potential wrongs. As previously noted, there are now mechanisms in place for preregistration of experimental designs and growing acceptance of the importance of doing so. Further, organizations that provide for open science (e.g., easy and efficient preregistration) are receiving millions of dollars in funding to provide support for researchers seeking to perform more rigorous research. Moreover, replication efforts—beyond even that of the Open Science Collaboration—are becoming more common (Klein et al, 2013). Overall, it appears that most scientists now recognize replicability as a concern that needs to be addressed with meaningful changes to what has constituted “business-as-usual” for so many years.

Effectively addressing the replicability crisis is important for any profession that relies on scientific evidence. Within the field of law, for example, science is used every day in courtrooms throughout the world to prosecute criminal cases and adjudicate civil disputes. Everyone from a criminal defendant facing capital punishment to a major corporation arguing that its violent video games did not promote real-life violence may rely at some point in a trial on a study published in a psychology journal. Appeals are sometimes limited. Costs associated with legal proceedings are often prohibitive. With a momentous verdict in the offing, none of the litigants has the luxury of time—which might amount to decades, if at all—for the scholarly research system to self-correct.

When it comes to psychology’s replicability crisis, there is good and bad news. The bad news is that it is real, and that it has existed perhaps, since scientific studies were first published. The good news is that the problem has finally been recognized, and constructive steps are being taken to address it.

Used with permission of Jason Chin.

*This Close-Up was guest-authored by Jason Chin of the University of Toronto.

Page 149

Parallel-Forms and Alternate-Forms Reliability Estimates

If you have ever taken a makeup exam in which the questions were not all the same as on the test initially given, you have had experience with different forms of a test. And if you have ever wondered whether the two forms of the test were really equivalent, you have wondered about the alternate-forms or parallel-forms reliability of the test. The degree of the relationship between various forms of a test can be evaluated by means of an alternate-forms or parallel-forms coefficient of reliability, which is often termed the  coefficient of equivalence .

Although frequently used interchangeably, there is a difference between the terms alternate forms and parallel forms.  Parallel forms  of a test exist when, for each form of the test, the means and the variances of observed test scores are equal. In theory, the means of scores obtained on parallel forms correlate equally with the true score. More practically, scores obtained on parallel tests correlate equally with other measures. The term  parallel forms reliability  refers to an estimate of the extent to which item sampling and other errors have affected test scores on versions of the same test when, for each form of the test, the means and variances of observed test scores are equal.

Alternate forms  are simply different versions of a test that have been constructed so as to be parallel. Although they do not meet the requirements for the legitimate designation “parallel,” alternate forms of a test are typically designed to be equivalent with respect to variables such as content and level of difficulty. The term  alternate forms reliability  refers to an estimate of the extent to which these different forms of the same test have been affected by item sampling error, or other error.

JUST THINK . . .

You missed the midterm examination and have to take a makeup exam. Your classmates tell you that they found the midterm impossibly difficult. Your instructor tells you that you will be taking an alternate form, not a parallel form, of the original test. How do you feel about that?

Obtaining estimates of alternate-forms reliability and parallel-forms reliability is similar in two ways to obtaining an estimate of test-retest reliability: (1) Two test administrations with the same group are required, and (2) test scores may be affected by factors such as motivation, fatigue, or intervening events such as practice, learning, or therapy (although not as much as when the same test is administered twice). An additional source of error variance, item sampling, is inherent in the computation of an alternate- or parallel-forms reliability coefficient. Testtakers may do better or worse on a specific form of the test not as a function of their true ability but simply because of the particular items that were selected for inclusion in the test.3

Developing alternate forms of tests can be time-consuming and expensive. Imagine what might be involved in trying to create sets of equivalent items and then getting the same people to sit for repeated administrations of an experimental test! On the other hand, once an alternate or parallel form of a test has been developed, it is advantageous to the test user in several ways. For example, it minimizes the effect of memory for the content of a previously administered form of the test.

JUST THINK . . .

From the perspective of the test user, what are other possible advantages of having alternate or parallel forms of the same test?

Certain traits are presumed to be relatively stable in people over time, and we would expect tests measuring those traits—alternate forms, parallel forms, or otherwise—to reflect that stability. As an example, we expect that there will be, and in fact there is, a reasonable degree of stability in scores on intelligence tests. Conversely, we might expect relatively little stability in scores obtained on a measure of state anxiety (anxiety felt at the moment).Page 150

An estimate of the reliability of a test can be obtained without developing an alternate form of the test and without having to administer the test twice to the same people. Deriving this type of estimate entails an evaluation of the internal consistency of the test items. Logically enough, it is referred to as an  internal consistency estimate of reliability  or as an  estimate of inter-item consistency . There are different methods of obtaining internal consistency estimates of reliability. One such method is the split-half estimate.

Split-Half Reliability Estimates

An estimate of  split-half reliability  is obtained by correlating two pairs of scores obtained from equivalent halves of a single test administered once. It is a useful measure of reliability when it is impractical or undesirable to assess reliability with two tests or to administer a test twice (because of factors such as time or expense). The computation of a coefficient of split-half reliability generally entails three steps:

· Step 1. Divide the test into equivalent halves.

· Step 2. Calculate a Pearson r between scores on the two halves of the test.

· Step 3. Adjust the half-test reliability using the Spearman–Brown formula (discussed shortly).

When it comes to calculating split-half reliability coefficients, there’s more than one way to split a test—but there are some ways you should never split a test. Simply dividing the test in the middle is not recommended because it’s likely that this procedure would spuriously raise or lower the reliability coefficient. Different amounts of fatigue for the first as opposed to the second part of the test, different amounts of test anxiety, and differences in item difficulty as a function of placement in the test are all factors to consider.

One acceptable way to split a test is to randomly assign items to one or the other half of the test. Another acceptable way to split a test is to assign odd-numbered items to one half of the test and even-numbered items to the other half. This method yields an estimate of split-half reliability that is also referred to as  odd-even reliability . 4 Yet another way to split a test is to divide the test by content so that each half contains items equivalent with respect to content and difficulty. In general, a primary objective in splitting a test in half for the purpose of obtaining a split-half reliability estimate is to create what might be called “mini-parallel-forms,” with each half equal to the other—or as nearly equal as humanly possible—in format, stylistic, statistical, and related aspects.

Step 2 in the procedure entails the computation of a Pearson r, which requires little explanation at this point. However, the third step requires the use of the Spearman–Brown formula.

The Spearman–Brown formula

The  Spearman–Brown formula  allows a test developer or user to estimate internal consistency reliability from a correlation of two halves of a test. It is a specific application of a more general formula to estimate the reliability of a test that is lengthened or shortened by any number of items. Because the reliability of a test is affected by its length, a formula is necessary for estimating the reliability of a test that has been shortened or lengthened. The general Spearman–Brown (rSB) formula is

Page 151

where rSB is equal to the reliability adjusted by the Spearman–Brown formula, rxy is equal to the Pearson r in the original-length test, and n is equal to the number of items in the revised version divided by the number of items in the original version.

By determining the reliability of one half of a test, a test developer can use the Spearman–Brown formula to estimate the reliability of a whole test. Because a whole test is two times longer than half a test, n becomes 2 in the Spearman–Brown formula for the adjustment of split-half reliability. The symbol rhh stands for the Pearson r of scores in the two half tests:

 

Usually, but not always, reliability increases as test length increases. Ideally, the additional test items are equivalent with respect to the content and the range of difficulty of the original items. Estimates of reliability based on consideration of the entire test therefore tend to be higher than those based on half of a test. Table 5–1 shows half-test correlations presented alongside adjusted reliability estimates for the whole test. You can see that all the adjusted correlations are higher than the unadjusted correlations. This is so because Spearman–Brown estimates are based on a test that is twice as long as the original half test. For the data from the kindergarten pupils, for example, a half-test reliability of .718 is estimated to be equivalent to a whole-test reliability of .836.

Grade Half-Test Correlation (unadjusted r ) Whole-Test  Estimate (rSB)
K .718 .836
1 .807 .893
2 .777 .875
Table 5–1

Odd-Even Reliability Coefficients before and after the Spearman-Brown Adjustment*

*For scores on a test of mental ability

If test developers or users wish to shorten a test, the Spearman–Brown formula may be used to estimate the effect of the shortening on the test’s reliability. Reduction in test size for the purpose of reducing test administration time is a common practice in certain situations. For example, the test administrator may have only limited time with a particular testtaker or group of testtakers. Reduction in test size may be indicated in situations where boredom or fatigue could produce responses of questionable meaningfulness.

JUST THINK . . .

What are other situations in which a reduction in test size or the time it takes to administer a test might be desirable? What are the arguments against reducing test size?

A Spearman–Brown formula could also be used to determine the number of items needed to attain a desired level of reliability. In adding items to increase test reliability to a desired level, the rule is that the new items must be equivalent in content and difficulty so that the longer test still measures what the original test measured. If the reliability of the original test is relatively low, then it may be impractical to increase the number of items to reach an acceptable level of reliability. Another alternative would be to abandon this relatively unreliable instrument and locate—or develop—a suitable alternative. The reliability of the instrument could also be raised in some way. For example, the reliability of the instrument might be raised by creating new items, clarifying the test’s instructions, or simplifying the scoring rules.

Internal consistency estimates of reliability, such as that obtained by use of the Spearman–Brown formula, are inappropriate for measuring the reliability of heterogeneous tests and speed tests. The impact of test characteristics on reliability is discussed in detail later in this chapter.Page 152

Other Methods of Estimating Internal Consistency

In addition to the Spearman–Brown formula, other methods used to obtain estimates of internal consistency reliability include formulas developed by Kuder and Richardson (1937) and Cronbach (1951).  Inter-item consistency  refers to the degree of correlation among all the items on a scale. A measure of inter-item consistency is calculated from a single administration of a single form of a test. An index of inter-item consistency, in turn, is useful in assessing the  homogeneity  of the test. Tests are said to be homogeneous if they contain items that measure a single trait. As an adjective used to describe test items, homogeneity (derived from the Greek words homos, meaning “same,” and genos, meaning “kind”) is the degree to which a test measures a single factor. In other words, homogeneity is the extent to which items in a scale are unifactorial.

In contrast to test homogeneity,  heterogeneity  describes the degree to which a test measures different factors. A heterogeneous (or nonhomogeneous) test is composed of items that measure more than one trait. A test that assesses knowledge only of ultra high definition (UHD) television repair skills could be expected to be more homogeneous in content than a general electronics repair test. The former test assesses only one area whereas the latter assesses several, such as knowledge not only of UHD televisions but also of digital video recorders, Blu-Ray players, MP3 players, satellite radio receivers, and so forth.

The more homogeneous a test is, the more inter-item consistency it can be expected to have. Because a homogeneous test samples a relatively narrow content area, it is to be expected to contain more inter-item consistency than a heterogeneous test. Test homogeneity is desirable because it allows relatively straightforward test-score interpretation. Testtakers with the same score on a homogeneous test probably have similar abilities in the area tested. Testtakers with the same score on a more heterogeneous test may have quite different abilities.

Although a homogeneous test is desirable because it so readily lends itself to clear interpretation, it is often an insufficient tool for measuring multifaceted psychological variables such as intelligence or personality. One way to circumvent this potential source of difficulty has been to administer a series of homogeneous tests, each designed to measure some component of a heterogeneous variable.5

The Kuder–Richardson formulas

Dissatisfaction with existing split-half methods of estimating reliability compelled G. Frederic Kuder and M. W. Richardson (1937; Richardson & Kuder, 1939) to develop their own measures for estimating reliability. The most widely known of the many formulas they collaborated on is their  Kuder–Richardson formula 20 , or KR-20, so named because it was the 20th formula developed in a series. Where test items are highly homogeneous, KR-20 and split-half reliability estimates will be similar. However, KR-20 is the statistic of choice for determining the inter-item consistency of dichotomous items, primarily those items that can be scored right or wrong (such as multiple-choice items). If test items are more heterogeneous, KR-20 will yield lower reliability estimates than the split-half method. Table 5–2 summarizes items on a sample heterogeneous test (the HERT), and Table 5–3 summarizes HERT performance for 20 testtakers. Assuming the difficulty level of all the items on the test to be about the same, would you expect a split-half (odd-even) estimate of reliability to be fairly high or low? How would the KR-20 reliability estimate compare with the odd-even estimate of reliability—would it be higher or lower?

Item Number Content Area
1 UHD television
2 UHD television
3 Digital video recorder (DVR)
4 Digital video recorder (DVR)
5 Blu-Ray player
6 Blu-Ray player
7 Smart phone
8 Smart phone
9 Computer
10 Computer
11 Compact disc player
12 Compact disc player
13 Satellite radio receiver
14 Satellite radio receiver
15 Video camera
16 Video camera
17 MP3 player
18 MP3 player
Table 5–2

Content Areas Sampled for 18 Items of the Hypothetical Electronics Repair Test (HERT)

Item Number Number of Testtakers Correct
1 14
2 12
3 9
4 18
5 8
6 5
7 6
8 9
9 10
10 10
11 8
12 6
13 15
14 9
15 12
16 12
17 14
18 7
Table 5–3

Performance on the 18-Item HERT by Item for 20 Testtakers

We might guess that, because the content areas sampled for the 18 items from this “Hypothetical Electronics Repair Test” are ordered in a manner whereby odd and even items Page 153tap the same content area, the odd-even reliability estimate will probably be quite high. Because of the great heterogeneity of content areas when taken as a whole, it could reasonably be predicted that the KR-20 estimate of reliability will be lower than the odd-even one. How is KR-20 computed? The following formula may be used:

 

where rKR20 stands for the Kuder–Richardson formula 20 reliability coefficient, k is the number of test items, σ2 is the variance of total test scores, p is the proportion of testtakers who pass the item, q is the proportion of people who fail the item, and Σ pq is the sum of the pq products over all items. For this particular example, k equals 18. Based on the data in Table 5–3, Σpq can be computed to be 3.975. The variance of total test scores is 5.26. Thus, rKR20 = .259.

An approximation of KR-20 can be obtained by the use of the 21st formula in the series developed by Kuder and Richardson, a formula known as—you guessed it—KR-21. The KR-21 formula may be used if there is reason to assume that all the test items have approximately Page 154the same degree of difficulty. Let’s add that this assumption is seldom justified. Formula KR-21 has become outdated in an era of calculators and computers. Way back when, KR-21 was sometimes used to estimate KR-20 only because it required many fewer calculations.

Numerous modifications of Kuder–Richardson formulas have been proposed through the years. The one variant of the KR-20 formula that has received the most acceptance and is in widest use today is a statistic called coefficient alpha. You may even hear it referred to as coefficient α−20. This expression incorporates both the Greek letter alpha (α) and the number 20, the latter a reference to KR-20.

Coefficient alpha

Developed by Cronbach (1951) and subsequently elaborated on by others (such as Kaiser & Michael, 1975; Novick & Lewis, 1967),  coefficient alpha  may be thought of as the mean of all possible split-half correlations, corrected by the Spearman–Brown formula. In contrast to KR-20, which is appropriately used only on tests with dichotomous items, coefficient alpha is appropriate for use on tests containing nondichotomous items. The formula for coefficient alpha is

 

where ra is coefficient alpha, k is the number of items, is the variance of one item, Σ is the sum of variances of each item, and σ2 is the variance of the total test scores.

Coefficient alpha is the preferred statistic for obtaining an estimate of internal consistency reliability. A variation of the formula has been developed for use in obtaining an estimate of test-retest reliability (Green, 2003). Essentially, this formula yields an estimate of the mean of all possible test-retest, split-half coefficients. Coefficient alpha is widely used as a measure of reliability, in part because it requires only one administration of the test.

Unlike a Pearson r, which may range in value from −1 to +1, coefficient alpha typically ranges in value from 0 to 1. The reason for this is that, conceptually, coefficient alpha (much like other coefficients of reliability) is calculated to help answer questions about how similar sets of data are. Here, similarity is gauged, in essence, on a scale from 0 (absolutely no similarity) to 1 (perfectly identical). It is possible, however, to conceive of data sets that would yield a negative value of alpha (Streiner, 2003b). Still, because negative values of alpha are theoretically impossible, it is recommended under such rare circumstances that the alpha coefficient be reported as zero (Henson, 2001). Also, a myth about alpha is that “bigger is always better.” As Streiner (2003b) pointed out, a value of alpha above .90 may be “too high” and indicate redundancy in the items.

In contrast to coefficient alpha, a Pearson r may be thought of as dealing conceptually with both dissimilarity and similarity. Accordingly, an r value of −1 may be thought of as indicating “perfect dissimilarity.” In practice, most reliability coefficients—regardless of the specific type of reliability they are measuring—range in value from 0 to 1. This is generally true, although it is possible to conceive of exceptional cases in which data sets yield an r with a negative value.

Average proportional distance (APD)

A relatively new measure for evaluating the internal consistency of a test is the average proportional distance (APD) method (Sturman et al., 2009). Rather than focusing on similarity between scores on items of a test (as do split-half methods and Cronbach’s alpha), the APD is a measure that focuses on the degree of difference that exists between item scores. Accordingly, we define the  average proportional distance method  as a measure used to evaluate the internal consistency of a test that focuses on the degree of difference that exists between item scores.

To illustrate how the APD is calculated, consider the (hypothetical) “3-Item Test of Extraversion” (3-ITE). As conveyed by the title of the 3-ITE, it is a test that has only three Page 155items. Each of the items is a sentence that somehow relates to extraversion. Testtakers are instructed to respond to each of the three items with reference to the following 7-point scale: 1 = Very strongly disagree, 2 = Strongly disagree, 3 = Disagree, 4 = Neither Agree nor Disagree, 5 = Agree, 6 = Strongly agree, and 7 = Very strongly agree.

Typically, in order to evaluate the inter-item consistency of a scale, the calculation of the APD would be calculated for a group of testtakers. However, for the purpose of illustrating the calculations of this measure, let’s look at how the APD would be calculated for one testtaker. Yolanda scores 4 on Item 1, 5 on Item 2, and 6 on Item 3. Based on Yolanda’s scores, the APD would be calculated as follows:

· Step 1: Calculate the absolute difference between scores for all of the items.

· Step 2: Average the difference between scores.

· Step 3: Obtain the APD by dividing the average difference between scores by the number of response options on the test, minus one.

So, for the 3-ITE, here is how the calculations would look using Yolanda’s test scores:

· Step 1: Absolute difference between Items 1 and 2 = 1

·    Absolute difference between Items 1 and 3 = 2

·    Absolute difference between Items 2 and 3 = 1

· Step 2: In order to obtain the average difference (AD), add up the absolute differences in Step 1 and divide by the number of items as follows:

 

· Step 3: To obtain the average proportional distance (APD), divide the average difference by 6 (the 7 response options in our ITE scale minus 1). Using Yolanda’s data, we would divide 1.33 by 6 to get .22. Thus, the APD for the ITE is .22. But what does this mean?

The general “rule of thumb” for interpreting an APD is that an obtained value of .2 or lower is indicative of excellent internal consistency, and that a value of .25 to .2 is in the acceptable range. A calculated APD of .25 is suggestive of problems with the internal consistency of the test. These guidelines are based on the assumption that items measuring a single construct such as extraversion should ideally be correlated with one another in the .6 to .7 range. Let’s add that the expected inter-item correlation may vary depending on the variables being measured, so the ideal correlation values are not set in stone. In the case of the 3-ITE, the data for our one subject suggests that the scale has acceptable internal consistency. Of course, in order to make any meaningful conclusions about the internal consistency of the 3-ITE, the instrument would have to be tested with a large sample of testtakers.

One potential advantage of the APD method over using Cronbach’s alpha is that the APD index is not connected to the number of items on a measure. Cronbach’s alpha will be higher when a measure has more than 25 items (Cortina, 1993). Perhaps the best course of action when evaluating the internal consistency of a given measure is to analyze and integrate the information using several indices, including Cronbach’s alpha, mean inter-item correlations, and the APD.

Before proceeding, let’s emphasize that all indices of reliability provide an index that is a characteristic of a particular group of test scores, not of the test itself (Caruso, 2000; Yin & Fan, 2000). Measures of reliability are estimates, and estimates are subject to error. The precise amount of error inherent in a reliability estimate will vary with various factors, such as the sample of testtakers from which the data were drawn. A reliability index published in a test manual might be very impressive. However, keep in mind that the reported reliability was achieved with a particular group of testtakers. If a new group of testtakers is sufficiently Page 156different from the group of testtakers on whom the reliability studies were done, the reliability coefficient may not be as impressive—and may even be unacceptable.

Measures of Inter-Scorer Reliability

When being evaluated, we usually would like to believe that the results would be the same no matter who is doing the evaluating.6 For example, if you take a road test for a driver’s license, you would like to believe that whether you pass or fail is solely a matter of your performance behind the wheel and not a function of who is sitting in the passenger’s seat. Unfortunately, in some types of tests under some conditions, the score may be more a function of the scorer than of anything else. This was demonstrated back in 1912, when researchers presented one pupil’s English composition to a convention of teachers and volunteers graded the papers. The grades ranged from a low of 50% to a high of 98% (Starch & Elliott, 1912). Concerns about inter-scorer reliability are as relevant today as they were back then (Chmielewski et al., 2015; Edens et al., 2015; Penney et al., 2016). With this as background, it can be appreciated that certain tests lend themselves to scoring in a way that is more consistent than with other tests. It is meaningful, therefore, to raise questions about the degree of consistency, or reliability, that exists between scorers of a particular test.

Variously referred to as scorer reliability, judge reliability, observer reliability, and inter-rater reliability,  inter-scorer reliability  is the degree of agreement or consistency between two or more scorers (or judges or raters) with regard to a particular measure. Reference to levels of inter-scorer reliability for a particular test may be published in the test’s manual or elsewhere. If the reliability coefficient is high, the prospective test user knows that test scores can be derived in a systematic, consistent way by various scorers with sufficient training. A responsible test developer who is unable to create a test that can be scored with a reasonable degree of consistency by trained scorers will go back to the drawing board to discover the reason for this problem. If, for example, the problem is a lack of clarity in scoring criteria, then the remedy might be to rewrite the scoring criteria section of the manual to include clearly written scoring rules. Inter-rater consistency may be promoted by providing raters with the opportunity for group discussion along with practice exercises and information on rater accuracy (Smith, 1986).

Inter-scorer reliability is often used when coding nonverbal behavior. For example, a researcher who wishes to quantify some aspect of nonverbal behavior, such as depressed mood, would start by composing a checklist of behaviors that constitute depressed mood (such as looking downward and moving slowly). Accordingly, each subject would be given a depressed mood score by a rater. Researchers try to guard against such ratings being products of the rater’s individual biases or idiosyncrasies in judgment. This can be accomplished by having at least one other individual observe and rate the same behaviors. If consensus can be demonstrated in the ratings, the researchers can be more confident regarding the accuracy of the ratings and their conformity with the established rating system.

JUST THINK . . .

Can you think of a measure in which it might be desirable for different judges, scorers, or raters to have different views on what is being judged, scored, or rated?

Perhaps the simplest way of determining the degree of consistency among scorers in the scoring of a test is to calculate a coefficient of correlation. This correlation coefficient is referred to as a  coefficient of inter-scorer reliability . In this chapter’s  Everyday Psychometrics  section, the nature of the relationship between the specific method used and the resulting estimate of diagnostic reliability is considered in greater detail.Page 157

EVERYDAY PSYCHOMETRICS

The Importance of the Method Used for Estimating Reliability*

As noted throughout this text, reliability is extremely important in its own right and is also a necessary, but not sufficient, condition for validity. However, researchers often fail to understand that the specific method used to obtain reliability estimates can lead to large differences in those estimates, even when other factors (such as subject sample, raters, and specific reliability statistic used) are held constant. A published study by Chmielewski et al. (2015) highlighted the substantial influence that differences in method can have on estimates of inter-rater reliability.

As one might expect, high levels of diagnostic (inter-rater) reliability are vital for the accurate diagnosis of psychiatric/psychological disorders. Diagnostic reliability must be acceptably high in order to accurately identify risk factors for a disorder that are common to subjects in a research study. Without satisfactory levels of diagnostic reliability, it becomes nearly impossible to accurately determine the effectiveness of treatments in clinical trials. Low diagnostic reliability can also lead to improper information regarding how a disorder changes over time. In applied clinical settings, unreliable diagnoses can result in ineffective patient care—or worse. The utility and validity of a particular diagnosis itself can be called into question if expert diagnosticians cannot, for whatever reason, consistently agree on who should and should not be so diagnosed. In sum, high levels of diagnostic reliability are essential for establishing diagnostic validity (Freedman, 2013; Nelson-Gray, 1991).

The official nomenclature of psychological/psychiatric diagnoses in the United States is the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013), which provides explicit diagnostic criteria for all mental disorders. A perceived strength of recent versions of the DSM is that disorders listed in the manual can be diagnosed with a high level of inter-rater reliability (Hyman, 2010; Nathan & Langenbucher, 1999), especially when trained professionals use semistructured interviews to assign those diagnoses. However, the field trials for the newest version of the manual, the DSM-5, demonstrated a mean kappa of only .44 (Regier et al., 2013), which is considered a “fair” level of agreement that is only moderately greater than chance (Cicchetti, 1994; Fleiss, 1981). Moreover, DSM-5 kappas were much lower than those from previous versions of the manual which had been in the “excellent” range. As one might expect, given the assumption that psychiatric diagnoses are reliable, the results of the DSM-5 field trials caused considerable controversy and led to numerous criticisms of the new manual (Frances, 2012; Jones, 2012). Interestingly, several diagnoses, which were unchanged from previous versions of the manual, also demonstrated low diagnostic reliability suggesting that the manual itself was not responsible for the apparent reduction in reliability. Instead, differences in the methods used to obtain estimates of inter-rater reliability in the DSM-5 Field Trials, compared to estimates for previous versions of the manual, may have led to the lower observed diagnostic reliability.

Prior to DSM-5, estimates of DSM inter-rater reliability were largely derived using the audio-recording method. In the audio-recording method, one clinician interviews a patient and assigns diagnoses. Then a second clinician, who does not know what diagnoses were assigned, listens to an audio-recording (or watches a video-recording) of the interview and independently assigns diagnoses. These two sets of ratings are then used to calculate inter-rater reliability coefficients (such as kappa). However, in recent years, several researchers have made the case that the audio-recording method might inflate estimates of diagnostic reliability for a variety of reasons (Chmielewski et al., 2015; Kraemer et al., 2012). First, if the interviewing clinician decides the patient they are interviewing does not meet diagnostic criteria for a disorder, they typically do not ask about any remaining symptoms of the disorder (this is a feature of semistructured interviews designed to reduce administration times). However, it also means that the clinician listening to the audio-tape, even if they believe the patient might meet diagnostic criteria for a disorder, does not have all the information necessary to assign a diagnosis and therefore is forced to agree that no diagnosis is present. Second, only the interviewing clinician can follow up patient responses with further questions or obtain clarification regarding symptoms to help them make a decision. Third, even when semistructured interviews are used it is possible that two highly trained clinicians might obtain different responses from a patient if they had each conducted their own interview. In other words, the patient may volunteer more or perhaps even different information to one of the clinicians for any number of reasons. All of the above result in the audio- or video-recording method artificially constraining the information provided to the clinicians to be identical, which is unlikely to occur in actual research or Page 158clinical settings. As such, this method does not allow for truly independent ratings and therefore likely results in overestimates of what would be obtained if separate interviews were conducted.

In the test-retest method, separate independent interviews are conducted by two different clinicians, with neither clinician knowing what occurred during the other interview. These interviews are conducted over a time frame short enough that true change in diagnostic status is highly unlikely, making this method similar to the dependability method of assessing reliability (Chmielewski & Watson, 2009). Because diagnostic reliability is intended to assess the extent to which a patient would receive the same diagnosis at different hospitals or clinics—or, alternatively, the extent to which different studies are recruiting similar patients—the test-retest method provides a more meaningful, realistic, and ecologically valid estimate of diagnostic reliability.

Chmielewski et al. (2015) examined the influence of method on estimates of reliability by using both the audio-recording and test-retest methods in a large sample of psychiatric patients. The authors’ analyzed DSM-5 diagnoses because of the long-standing claims in the literature that they were reliable and the fact that structured interviews had not yet been created for the DSM-5. They carefully selected a one-week test-retest interval, based on theory and research, to minimize the likelihood that true diagnostic change would occur while substantially reducing memory effects and patient fatigue which might exist if the interviews were conducted immediately after each other. Clinicians in the study were at least master’s level and underwent extensive training that far exceeded the training of clinicians in the vast majority of research studies. The same pool of clinicians and patients was used for the audio-recording and test-retest methods. Diagnoses were assigned using the Structured Clinical Interview for DSM-IV (SCID-I/P; First et al., 2002), which is widely considered the gold-standard diagnostic interview in the field. Finally, patients completed self-report measures which were examined to ensure patients’ symptoms did not change over the one-week interval.

Diagnostic (inter-rater) reliability using the audio-recording method was very high (mean kappa = .80) and would be considered “excellent” by traditional standards (Cicchetti, 1994; Fleiss, 1981). Moreover, estimates of diagnostic reliability were equivalent or superior to previously published values for the DSM-5. However, estimates of diagnostic reliability obtained from the test-retest method were substantially lower (mean kappa = .47) and would be considered only “fair” by traditional standards. Moreover, approximately 25% of the disorders demonstrated “poor” diagnostic reliability. Interestingly, this level of diagnostic reliability was very similar to that observed in the DSM-5 Field Trials (mean kappa = .44), which also used the test-retest method (Regier et al., 2013). It is important to note these large differences in estimates of diagnostic reliability emerged despite the fact that (1) the same highly trained master’s-level clinicians were used for both methods; (2) the SCID-I/P, which is considered the “gold standard” in diagnostic interviews, was used; (3) the same patient sample was used; and (4) patients’ self-report of their symptoms was very stable (or, patients were experiencing their symptoms the same way during both interviews) and any changes in self-report were unrelated to diagnostic disagreements between clinicians. These results suggest that the reliability of diagnoses is far lower than commonly believed. Moreover, the results demonstrate the substantial influence that method has on estimates of diagnostic reliability even when other factors are held constant.

Used with permission of Michael Chmielewski.

*This Everyday Psychometrics was guest-authored by Michael Chmielewski of Southern Methodist University and was based on an article by Chmielewski et al. (2015), published in the Journal of Abnormal Psychology (copyright © 2015 by the American Psychological Association). The use of this information does not imply endorsement by the publisher.

Using and Interpreting a Coefficient of Reliability

We have seen that, with respect to the test itself, there are basically three approaches to the estimation of reliability: (1) test-retest, (2) alternate or parallel forms, and (3) internal or inter-item consistency. The method or methods employed will depend on a number of factors, such as the purpose of obtaining a measure of reliability.

Another question that is linked in no trivial way to the purpose of the test is, “How high should the coefficient of reliability be?” Perhaps the best “short answer” to this question is: Page 159“On a continuum relative to the purpose and importance of the decisions to be made on the basis of scores on the test.” Reliability is a mandatory attribute in all tests we use. However, we need more of it in some tests, and we will admittedly allow for less of it in others. If a test score carries with it life-or-death implications, then we need to hold that test to some high standards—including relatively high standards with regard to coefficients of reliability. If a test score is routinely used in combination with many other test scores and typically accounts for only a small part of the decision process, that test will not be held to the highest standards of reliability. As a rule of thumb, it may be useful to think of reliability coefficients in a way that parallels many grading systems: In the .90s rates a grade of A (with a value of .95 higher for the most important types of decisions), in the .80s rates a B (with below .85 being a clear B−), and anywhere from .65 through the .70s rates a weak, “barely passing” grade that borders on failing (and unacceptable). Now, let’s get a bit more technical with regard to the purpose of the reliability coefficient.

The Purpose of the Reliability Coefficient

If a specific test of employee performance is designed for use at various times over the course of the employment period, it would be reasonable to expect the test to demonstrate reliability across time. It would thus be desirable to have an estimate of the instrument’s test-retest reliability. For a test designed for a single administration only, an estimate of internal consistency would be the reliability measure of choice. If the purpose of determining reliability is to break down the error variance into its parts, as shown in Figure 5–1, then a number of reliability coefficients would have to be calculated.

Figure 5–1  Sources of Variance in a Hypothetical Test  In this hypothetical situation, 5% of the variance has not been identified by the test user. It is possible, for example, that this portion of the variance could be accounted for by  transient error,  a source of error attributable to variations in the testtaker’s feelings, moods, or mental state over time. Then again, this 5% of the error may be due to other factors that are yet to be identified.

Note that the various reliability coefficients do not all reflect the same sources of error variance. Thus, an individual reliability coefficient may provide an index of error from test construction, test administration, or test scoring and interpretation. A coefficient of inter-rater reliability, for example, provides information about error as a result of test scoring. Specifically, it can be used to answer questions about how consistently two scorers score the same test items. Table 5–4 summarizes the different kinds of error variance that are reflected in different reliability coefficients.

Page 160

Type of Reliability Purpose Typical uses Number of  Testing Sessions Sources of Error Variance Statistical Procedures
· Test-retest · To evaluate the stabilityof a measure · When assessing the stability of various personality traits · 2 · Administration · Pearson r or Spearman rho
· Alternate-forms · To evaluate the relationship between different forms of a measure · When there is a need for different forms of a test (e.g., makeup tests) · 1 or 2 · Test construction or administration · Pearson r or Spearman rho
· Internal consistency · To evaluate the extent to which items on a scale relate to one another · When evaluating the homogeneity of a measure (or, all items are tapping a single construct) · 1 · Test construction · Pearson r between equivalent test halves with Spearman Brown correction or Kuder-R-ichardson for dichotomous items, or coefficient alpha for multipoint items or APD
· Inter-scorer · To evaluate the level of agreement between raters on a measure · Interviews or coding of behavior. Used when researchers need to show that there is consensus in the way that different raters view a particular behavior pattern (and hence no observer bias). · 1 · Scoring and interpretation · Cohen’s kappa, Pearson r or Spearman rho
Table 5–4

Summary of Reliability Types

The Nature of the Test

Closely related to considerations concerning the purpose and use of a reliability coefficient are those concerning the nature of the test itself. Included here are considerations such as whether (1) the test items are homogeneous or heterogeneous in nature; (2) the characteristic, ability, or trait being measured is presumed to be dynamic or static; (3) the range of test scores is or is not restricted; (4) the test is a speed or a power test; and (5) the test is or is not criterion-referenced.

Some tests present special problems regarding the measurement of their reliability. For example, a number of psychological tests have been developed for use with infants to help identify children who are developing slowly or who may profit from early intervention of some sort. Measuring the internal consistency reliability or the inter-scorer reliability of such tests is accomplished in much the same way as it is with other tests. However, measuring test-retest reliability presents a unique problem. The abilities of the very young children being tested are fast-changing. It is common knowledge that cognitive development during the first months and years of life is both rapid and uneven. Children often grow in spurts, sometimes changing dramatically in as little as days (Hetherington & Parke, 1993). The child tested just before and again just after a developmental advance may perform very differently on the two testings. In such cases, a marked change in test score might be attributed to error when in reality it reflects a genuine change in the testtaker’s skills. The challenge in gauging the test-retest reliability of such tests is to do so in such a way that it is not spuriously lowered by the testtaker’s actual Page 161developmental changes between testings. In attempting to accomplish this, developers of such tests may design test-retest reliability studies with very short intervals between testings, sometimes as little as four days.

Homogeneity versus heterogeneity of test items

Recall that a test is said to be homogeneous in items if it is functionally uniform throughout. Tests designed to measure one factor, such as one ability or one trait, are expected to be homogeneous in items. For such tests, it is reasonable to expect a high degree of internal consistency. By contrast, if the test is heterogeneous in items, an estimate of internal consistency might be low relative to a more appropriate estimate of test-retest reliability.

Dynamic versus static characteristics

Whether what is being measured by the test is dynamic or static is also a consideration in obtaining an estimate of reliability. A  dynamic characteristic  is a trait, state, or ability presumed to be ever-changing as a function of situational and cognitive experiences. If, for example, one were to take hourly measurements of the dynamic characteristic of anxiety as manifested by a stockbroker throughout a business day, one might find the measured level of this characteristic to change from hour to hour. Such changes might even be related to the magnitude of the Dow Jones average. Because the true amount of anxiety presumed to exist would vary with each assessment, a test-retest measure would be of little help in gauging the reliability of the measuring instrument. Therefore, the best estimate of reliability would be obtained from a measure of internal consistency. Contrast this situation to one in which hourly assessments of this same stockbroker are made on a trait, state, or ability presumed to be relatively unchanging (a  static characteristic ), such as intelligence. In this instance, obtained measurement would not be expected to vary significantly as a function of time, and either the test-retest or the alternate-forms method would be appropriate.

JUST THINK . . .

Provide another example of both a dynamic characteristic and a static characteristic that a psychological test could measure.

Restriction or inflation of range

In using and interpreting a coefficient of reliability, the issue variously referred to as  restriction of range  or  restriction of variance  (or, conversely,  inflation of range  or  inflation of variance ) is important. If the variance of either variable in a correlational analysis is restricted by the sampling procedure used, then the resulting correlation coefficient tends to be lower. If the variance of either variable in a correlational analysis is inflated by the sampling procedure, then the resulting correlation coefficient tends to be higher. Refer back to Figure 3–17 on page 111 (Two Scatterplots Illustrating Unrestricted and Restricted Ranges) for a graphic illustration.

Also of critical importance is whether the range of variances employed is appropriate to the objective of the correlational analysis. Consider, for example, a published educational test designed for use with children in grades 1 through 6. Ideally, the manual for this test should contain not one reliability value covering all the testtakers in grades 1 through 6 but instead reliability values for testtakers at each grade level. Here’s another example: A corporate personnel officer employs a certain screening test in the hiring process. For future testing and hiring purposes, this personnel officer maintains reliability data with respect to scores achieved by job applicants—as opposed to hired employees—in order to avoid restriction of range effects in the data. This is so because the people who were hired typically scored higher on the test than any comparable group of applicants.

Speed tests versus power tests

When a time limit is long enough to allow testtakers to attempt all items, and if some items are so difficult that no testtaker is able to obtain a perfect score, then the test is a  power test . By contrast, a  speed test  generally contains items of Page 162uniform level of difficulty (typically uniformly low) so that, when given generous time limits, all testtakers should be able to complete all the test items correctly. In practice, however, the time limit on a speed test is established so that few if any of the testtakers will be able to complete the entire test. Score differences on a speed test are therefore based on performance speed because items attempted tend to be correct.

A reliability estimate of a speed test should be based on performance from two independent testing periods using one of the following: (1) test-retest reliability, (2) alternate-forms reliability, or (3) split-half reliability from two separately timed half tests. If a split-half procedure is used, then the obtained reliability coefficient is for a half test and should be adjusted using the Spearman–Brown formula.

Because a measure of the reliability of a speed test should reflect the consistency of response speed, the reliability of a speed test should not be calculated from a single administration of the test with a single time limit. If a speed test is administered once and some measure of internal consistency, such as the Kuder–Richardson or a split-half correlation, is calculated, the result will be a spuriously high reliability coefficient. To understand why the KR-20 or split-half reliability coefficient will be spuriously high, consider the following example.

When a group of testtakers completes a speed test, almost all the items completed will be correct. If reliability is examined using an odd-even split, and if the testtakers completed the items in order, then testtakers will get close to the same number of odd as even items correct. A testtaker completing 82 items can be expected to get approximately 41 odd and 41 even items correct. A testtaker completing 61 items may get 31 odd and 30 even items correct. When the numbers of odd and even items correct are correlated across a group of testtakers, the correlation will be close to 1.00. Yet this impressive correlation coefficient actually tells us nothing about response consistency.

Under the same scenario, a Kuder–Richardson reliability coefficient would yield a similar coefficient that would also be, well, equally useless. Recall that KR-20 reliability is based on the proportion of testtakers correct (p) and the proportion of testtakers incorrect (q) on each item. In the case of a speed test, it is conceivable that p would equal 1.0 and q would equal 0 for many of the items. Toward the end of the test—when many items would not even be attempted because of the time limit—p might equal 0 and q might equal 1.0. For many, if not a majority, of the items, then, the product pq would equal or approximate 0. When 0 is substituted in the KR-20 formula for Σ pq, the reliability coefficient is 1.0 (a meaningless coefficient in this instance).

Criterion-referenced tests

 criterion-referenced test  is designed to provide an indication of where a testtaker stands with respect to some variable or criterion, such as an educational or a vocational objective. Unlike norm-referenced tests, criterion-referenced tests tend to contain material that has been mastered in hierarchical fashion. For example, the would-be pilot masters on-ground skills before attempting to master in-flight skills. Scores on criterion-referenced tests tend to be interpreted in pass–fail (or, perhaps more accurately, “master-failed-to-master”) terms, and any scrutiny of performance on individual items tends to be for diagnostic and remedial purposes.

Traditional techniques of estimating reliability employ measures that take into account scores on the entire test. Recall that a test-retest reliability estimate is based on the correlation between the total scores on two administrations of the same test. In alternate-forms reliability, a reliability estimate is based on the correlation between the two total scores on the two forms. In split-half reliability, a reliability estimate is based on the correlation between scores on two halves of the test and is then adjusted using the Spearman–Brown formula to obtain a reliability estimate of the whole test. Although there are exceptions, such traditional procedures of Page 163estimating reliability are usually not appropriate for use with criterion-referenced tests. To understand why, recall that reliability is defined as the proportion of total variance (σ2) attributable to true variance (σ2th). Total variance in a test score distribution equals the sum of the true variance plus the error variance (σe2)

 

A measure of reliability, therefore, depends on the variability of the test scores: how different the scores are from one another. In criterion-referenced testing, and particularly in mastery testing, how different the scores are from one another is seldom a focus of interest. In fact, individual differences between examinees on total test scores may be minimal. The critical issue for the user of a mastery test is whether or not a certain criterion score has been achieved.

As individual differences (and the variability) decrease, a traditional measure of reliability would also decrease, regardless of the stability of individual performance. Therefore, traditional ways of estimating reliability are not always appropriate for criterion-referenced tests, though there may be instances in which traditional estimates can be adopted. An example might be a situation in which the same test is being used at different stages in some program—training, therapy, or the like—and so variability in scores could reasonably be expected. Statistical techniques useful in determining the reliability of criterion-referenced tests are discussed in great detail in many sources devoted to that subject (e.g., Hambleton & Jurgensen, 1990).

The True Score Model of Measurement and Alternatives to It

Thus far—and throughout this book, unless specifically stated otherwise—the model we have assumed to be operative is  classical test theory (CTT) , also referred to as the true score (or classical) model of measurement. CTT is the most widely used and accepted model in the psychometric literature today—rumors of its demise have been greatly exaggerated (Zickar & Broadfoot, 2009). One of the reasons it has remained the most widely used model has to do with its simplicity, especially when one considers the complexity of other proposed models of measurement. Comparing CTT to IRT, for example, Streiner (2010) mused, “CTT is much simpler to understand than IRT; there aren’t formidable-looking equations with exponentiations, Greek letters, and other arcane symbols” (p. 185). Additionally, the CTT notion that everyone has a “true score” on a test has had, and continues to have, great intuitive appeal. Of course, exactly how to define this elusive true score has been a matter of sometimes contentious debate. For our purposes, we will define  true score  as a value that according to classical test theory genuinely reflects an individual’s ability (or trait) level as measured by a particular test. Let’s emphasize here that this value is indeed very test dependent. A person’s “true score” on one intelligence test, for example, can vary greatly from that same person’s “true score” on another intelligence test. Similarly, if “Form D” of an ability test contains items that the testtaker finds to be much more difficult than those on “Form E” of that test, then there is a good chance that the testtaker’s true score on Form D will be lower than that on Form E. The same holds for true scores obtained on different tests of personality. One’s true score on one test of extraversion, for example, may not bear much resemblance to one’s true score on another test of extraversion. Comparing a testtaker’s scores on two different tests purporting to measure the same thing requires a sophisticated knowledge of the properties of each of the two tests, as well as some rather complicated statistical procedures designed to equate the scores.

Another aspect of the appeal of CTT is that its assumptions allow for its application in most situations (Hambleton & Swaminathan, 1985). The fact that CTT assumptions are rather easily met and therefore applicable to so many measurement situations can be Page 164advantageous, especially for the test developer in search of an appropriate model of measurement for a particular application. Still, in psychometric parlance, CTT assumptions are characterized as “weak”—this precisely because its assumptions are so readily met. By contrast, the assumptions in another model of measurement, item response theory (IRT), are more difficult to meet. As a consequence, you may read of IRT assumptions being characterized in terms such as “strong,” “hard,” “rigorous,” and “robust.” A final advantage of CTT over any other model of measurement has to do with its compatibility and ease of use with widely used statistical techniques (as well as most currently available data analysis software). Factor analytic techniques, whether exploratory or confirmatory, are all “based on the CTT measurement foundation” (Zickar & Broadfoot, 2009, p. 52).

For all of its appeal, measurement experts have also listed many problems with CTT. For starters, one problem with CTT has to do with its assumption concerning the equivalence of all items on a test; that is, all items are presumed to be contributing equally to the score total. This assumption is questionable in many cases, and particularly questionable when doubt exists as to whether the scaling of the instrument in question is genuinely interval level in nature. Another problem has to do with the length of tests that are developed using a CTT model. Whereas test developers favor shorter rather than longer tests (as do most testtakers), the assumptions inherent in CTT favor the development of longer rather than shorter tests. For these reasons, as well as others, alternative measurement models have been developed. Below we briefly describe domain sampling theory and generalizability theory. We will then describe in greater detail, item response theory (IRT), a measurement model that some believe is a worthy successor to CTT (Borsbroom, 2005; Harvey & Hammer, 1999).

Domain sampling theory and generalizability theory

The 1950s saw the development of a viable alternative to CTT. It was originally referred to as domain sampling theory and is better known today in one of its many modified forms as generalizability theory. As set forth by Tryon (1957), the theory of domain sampling rebels against the concept of a true score existing with respect to the measurement of psychological constructs. Whereas those who subscribe to CTT seek to estimate the portion of a test score that is attributable to error, proponents of  domain sampling theory  seek to estimate the extent to which specific sources of variation under defined conditions are contributing to the test score. In domain sampling theory, a test’s reliability is conceived of as an objective measure of how precisely the test score assesses the domain from which the test draws a sample (Thorndike, 1985). A domain of behavior, or the universe of items that could conceivably measure that behavior, can be thought of as a hypothetical construct: one that shares certain characteristics with (and is measured by) the sample of items that make up the test. In theory, the items in the domain are thought to have the same means and variances of those in the test that samples from the domain. Of the three types of estimates of reliability, measures of internal consistency are perhaps the most compatible with domain sampling theory.

In one modification of domain sampling theory called generalizability theory, a “universe score” replaces that of a “true score” (Shavelson et al., 1989). Developed by Lee J. Cronbach (1970) and his colleagues (Cronbach et al., 1972),  generalizability theory  is based on the idea that a person’s test scores vary from testing to testing because of variables in the testing situation. Instead of conceiving of all variability in a person’s scores as error, Cronbach encouraged test developers and researchers to describe the details of the particular test situation or  universe  leading to a specific test score. This universe is described in terms of its  facets , which include things like the number of items in the test, the amount of training the test scorers have had, and the purpose of the test administration. Page 165According to generalizability theory, given the exact same conditions of all the facets in the universe, the exact same test score should be obtained. This test score is the  universe score , and it is, as Cronbach noted, analogous to a true score in the true score model. Cronbach (1970) explained as follows:

“What is Mary’s typing ability?” This must be interpreted as “What would Mary’s word processing score on this be if a large number of measurements on the test were collected and averaged?” The particular test score Mary earned is just one out of a universe of possible observations. If one of these scores is as acceptable as the next, then the mean, called the universe score and symbolized here by Mp (mean for person p), would be the most appropriate statement of Mary’s performance in the type of situation the test represents.

The universe is a collection of possible measures “of the same kind,” but the limits of the collection are determined by the investigator’s purpose. If he needs to know Mary’s typing ability on May 5 (for example, so that he can plot a learning curve that includes one point for that day), the universe would include observations on that day and on that day only. He probably does want to generalize over passages, testers, and scorers—that is to say, he would like to know Mary’s ability on May 5 without reference to any particular passage, tester, or scorer… .

The person will ordinarily have a different universe score for each universe. Mary’s universe score covering tests on May 5 will not agree perfectly with her universe score for the whole month of May… . Some testers call the average over a large number of comparable observations a “true score”; e.g., “Mary’s true typing rate on 3-minute tests.” Instead, we speak of a “universe score” to emphasize that what score is desired depends on the universe being considered. For any measure there are many “true scores,” each corresponding to a different universe.

When we use a single observation as if it represented the universe, we are generalizing. We generalize over scorers, over selections typed, perhaps over days. If the observed scores from a procedure agree closely with the universe score, we can say that the observation is “accurate,” or “reliable,” or “generalizable.” And since the observations then also agree with each other, we say that they are “consistent” and “have little error variance.” To have so many terms is confusing, but not seriously so. The term most often used in the literature is “reliability.” The author prefers “generalizability” because that term immediately implies “generalization to what?” … There is a different degree of generalizability for each universe. The older methods of analysis do not separate the sources of variation. They deal with a single source of variance, or leave two or more sources entangled. (Cronbach, 1970, pp. 153–154)

How can these ideas be applied? Cronbach and his colleagues suggested that tests be developed with the aid of a generalizability study followed by a decision study. A  generalizability study  examines how generalizable scores from a particular test are if the test is administered in different situations. Stated in the language of generalizability theory, a generalizability study examines how much of an impact different facets of the universe have on the test score. Is the test score affected by group as opposed to individual administration? Is the test score affected by the time of day in which the test is administered? The influence of particular facets on the test score is represented by  coefficients of generalizability . These coefficients are similar to reliability coefficients in the true score model.

After the generalizability study is done, Cronbach et al. (1972) recommended that test developers do a decision study, which involves the application of information from the generalizability study. In the  decision study , developers examine the usefulness of test scores in helping the test user make decisions. In practice, test scores are used to guide a variety of decisions, from placing a child in special education to hiring new employees to Page 166discharging mental patients from the hospital. The decision study is designed to tell the test user how test scores should be used and how dependable those scores are as a basis for decisions, depending on the context of their use. Why is this so important? Cronbach (1970) noted:

The decision that a student has completed a course or that a patient is ready for termination of therapy must not be seriously influenced by chance errors, temporary variations in performance, or the tester’s choice of questions. An erroneous favorable decision may be irreversible and may harm the person or the community. Even when reversible, an erroneous unfavorable decision is unjust, disrupts the person’s morale, and perhaps retards his development. Research, too, requires dependable measurement. An experiment is not very informative if an observed difference could be accounted for by chance variation. Large error variance is likely to mask a scientifically important outcome. Taking a better measure improves the sensitivity of an experiment in the same way that increasing the number of subjects does. (p. 152)

Generalizability has not replaced CTT. Perhaps one of its chief contributions has been its emphasis on the fact that a test’s reliability does not reside within the test itself. From the perspective of generalizability theory, a test’s reliability is very much a function of the circumstances under which the test is developed, administered, and interpreted.

Item response theory (IRT)

Another alternative to the true score model is item response theory (IRT; Lord & Novick, 1968; Lord, 1980). The procedures of item response theory provide a way to model the probability that a person with X ability will be able to perform at a level of Y. Stated in terms of personality assessment, it models the probability that a person with X amount of a particular personality trait will exhibit Y amount of that trait on a personality test designed to measure it. Because so often the psychological or educational construct being measured is physically unobservable (stated another way, is latent) and because the construct being measured may be a trait (it could also be something else, such as an ability), a synonym for IRT in the academic literature is  latent-trait theory . Let’s note at the outset, however, that IRT is not a term used to refer to a single theory or method. Rather, it refers to a family of theories and methods—and quite a large family at that—with many other names used to distinguish specific approaches. There are well over a hundred varieties of IRT models. Each model is designed to handle data with certain assumptions and data characteristics.

Examples of two characteristics of items within an IRT framework are the difficulty level of an item and the item’s level of discrimination; items may be viewed as varying in terms of these, as well as other, characteristics. “Difficulty” in this sense refers to the attribute of not being easily accomplished, solved, or comprehended. In a mathematics test, for example, a test item tapping basic addition ability will have a lower difficulty level than a test item tapping basic algebra skills. The characteristic of difficulty as applied to a test item may also refer to physical difficulty—that is, how hard or easy it is for a person to engage in a particular activity. Consider in this context three items on a hypothetical “Activities of Daily Living Questionnaire” (ADLQ), a true–false questionnaire designed to tap the extent to which respondents are physically able to participate in activities of daily living. Item 1 of this test is I am able to walk from room to room in my home. Item 2 is I require assistance to sit, stand, and walk. Item 3 is I am able to jog one mile a day, seven days a week. With regard to difficulty related to mobility, the respondent who answers true to item 1 and false to item 2 may be presumed to have more mobility than the respondent who answers false to item 1 and true to item 2. In classical test theory, each of these items might be scored with 1 point awarded to responses indicative Page 167of mobility and 0 points for responses indicative of a lack of mobility. Within IRT, however, responses indicative of mobility (as opposed to a lack of mobility or impaired mobility) may be assigned different weights. A true response to item 1 may therefore earn more points than a false response to item 2, and a true response to item 3 may earn more points than a true response to item 1.

In the context of IRT,  discrimination  signifies the degree to which an item differentiates among people with higher or lower levels of the trait, ability, or whatever it is that is being measured. Consider two more ADLQ items: item 4, My mood is generally good; and item 5, I am able to walk one block on flat ground. Which of these two items do you think would be more discriminating in terms of the respondent’s physical abilities? If you answered “item 5” then you are correct. And if you were developing this questionnaire within an IRT framework, you would probably assign differential weight to the value of these two items. Item 5 would be given more weight for the purpose of estimating a person’s level of physical activity than item 4. Again, within the context of classical test theory, all items of the test might be given equal weight and scored, for example, 1 if indicative of the ability being measured and 0 if not indicative of that ability.

A number of different IRT models exist to handle data resulting from the administration of tests with various characteristics and in various formats. For example, there are IRT models designed to handle data resulting from the administration of tests with  dichotomous test items  (test items or questions that can be answered with only one of two alternative responses, such as true–false, yes–no, or correct–incorrect questions). There are IRT models designed to handle data resulting from the administration of tests with  polytomous test items  (test items or questions with three or more alternative responses, where only one is scored correct or scored as being consistent with a targeted trait or other construct). Other IRT models exist to handle other types of data.

In general, latent-trait models differ in some important ways from CTT. For example, in CTT, no assumptions are made about the frequency distribution of test scores. By contrast, such assumptions are inherent in latent-trait models. As Allen and Yen (1979, p. 240) have pointed out, “Latent-trait theories propose models that describe how the latent trait influences performance on each test item. Unlike test scores or true scores, latent traits theoretically can take on values from −∞ to +∞ [negative infinity to positive infinity].” Some IRT models have very specific and stringent assumptions about the underlying distribution. In one group of IRT models developed by the Danish mathematician Georg Rasch, each item on the test is assumed to have an equivalent relationship with the construct being measured by the test. A shorthand reference to these types of models is “Rasch,” so reference to the  Rasch model  is a reference to an IRT model with very specific assumptions about the underlying distribution.

The psychometric advantages of IRT have made this model appealing, especially to commercial and academic test developers and to large-scale test publishers. It is a model that in recent years has found increasing application in standardized tests, professional licensing examinations, and questionnaires used in behavioral and social sciences (De Champlain, 2010). However, the mathematical sophistication of the approach has made it out of reach for many everyday users of tests such as classroom teachers or “mom and pop” employers (Reise & Henson, 2003). To learn more about the approach that Roid (2006) once characterized as having fostered “new rules of measurement” for ability testing ask your instructor to access the Instructor Resources within Connect and check out OOBAL-5-B2, “Item Response Theory (IRT).” More immediately, you can meet a “real-life” user of IRT in this chapter’s  Meet an Assessment Professional  feature.Page 168

MEET AN ASSESSMENT PROFESSIONAL

Meet Dr. Bryce B. Reeve

Iuse my skills and training as a psychometrician to design questionnaires and studies to capture the burden of cancer and its treatment on patients and their families… . The types of questionnaires I help to create measure a person’s health-related quality of life (HRQOL). HRQOL is a multidimensional construct capturing such domains as physical functioning, mental well-being, and social well-being. Different cancer types and treatments for those cancers may have different impact on the magnitude and which HRQOL domain is affected. All cancers can impact a person’s mental health with documented increases in depressive symptoms and anxiety… . There may also be positive impacts of cancer as some cancer survivors experience greater social well-being and appreciation of life. Thus, our challenge is to develop valid and precise measurement tools that capture these changes in patients’ lives. Psychometrically strong measures also allow us to evaluate the impact of new behavioral or pharmacological interventions developed to improve quality of life. Because many patients in our research studies are ill, it is important to have very brief questionnaires to minimize their burden responding to a battery of questionnaires.

… we … use both qualitative and quantitative methodologies to design … HRQOL instruments. We use qualitative methods like focus groups and cognitive interviewing to make sure we have captured the experiences and perspectives of cancer patients and to write questions that are comprehendible to people with low literacy skills or people of different cultures. We use quantitative methods to examine how well individual questions and scales perform for measuring the HRQOL domains. Specifically, we use classical test theory, factor analysis, and item response theory (IRT) to: (1) develop and refine questionnaires; (2) identify the performance of instruments across different age groups, males and females, and cultural/racial groups; and (3) to develop item banks which allow for creating standardized questionnaires or administering computerized adaptive testing (CAT).

Bryce B. Reeve, Ph.D., U.S. National Cancer Institute © Bryce B. Reeve/National Institute of Health

I use IRT models to get an in-depth look as to how questions and scales perform in our cancer research studies. [Using IRT], we were able to reduce a burdensome 21-item scale down to a brief 10-item scale… .

Differential item function (DIF) is a key methodology to identify … biased items in questionnaires. I have used IRT modeling to examine DIF in item responses on many HRQOL questionnaires. It is especially important to evaluate DIF in questionnaires that have been translated to multiple languages for the purpose of conducting international research studies. An instrument may be translated to have the same words in multiple languages, but the words themselves may have entirely different meaning to people of different cultures. For example, researchers at the University of Massachusetts found Chinese respondents gave lower satisfaction ratings of their medical doctors than non-Chinese. In a review of the translation, the “Excellent” response category translated into Chinese as “God-like.” IRT modeling gives me the ability to not only detect DIF items, but the flexibility to correct for bias as well. I can use IRT to look at unadjusted and adjusted IRT scores to see the effect of the DIF item without removing the item from the scale if the item is deemed relevant… .Page 169

The greatest challenges I found to greater application or acceptance of IRT methods in health care research are the complexities of the models themselves and lack of easy-to-understand resources and tools to train researchers. Many researchers have been trained in classical test theory statistics, are comfortable interpreting these statistics, and can use readily available software to generate easily familiar summary statistics, such as Cronbach’s coefficient α or item-total correlations. In contrast, IRT modeling requires an advanced knowledge of measurement theory to understand the mathematical complexities of the models, to determine whether the assumptions of the IRT models are met, and to choose the model from within the large family of IRT models that best fits the data and the measurement task at hand. In addition, the supporting software and literature are not well adapted for researchers outside the field of educational testing.

Read more of what Dr. Reeve had to say—his complete essay—through the Instructor Resources within Connect.

Used with permission of Bryce B. Reeve.

Reliability and Individual Scores

The reliability coefficient helps the test developer build an adequate measuring instrument, and it helps the test user select a suitable test. However, the usefulness of the reliability coefficient does not end with test construction and selection. By employing the reliability coefficient in the formula for the standard error of measurement, the test user now has another descriptive statistic relevant to test interpretation, this one useful in estimating the precision of a particular test score.

The Standard Error of Measurement

The standard error of measurement, often abbreviated as SEM or SEM, provides a measure of the precision of an observed test score. Stated another way, it provides an estimate of the amount of error inherent in an observed score or measurement. In general, the relationship between the SEM and the reliability of a test is inverse; the higher the reliability of a test (or individual subtest within a test), the lower the SEM.

To illustrate the utility of the SEM, let’s revisit The Rochester Wrenchworks (TRW) and reintroduce Mary (from Cronbach’s excerpt earlier in this chapter), who is now applying for a job as a word processor. To be hired at TRW as a word processor, a candidate must be able to word-process accurately at the rate of 50 words per minute. The personnel office administers a total of seven brief word-processing tests to Mary over the course of seven business days. In words per minute, Mary’s scores on each of the seven tests are as follows:

52 55 39 56 35 50 54

If you were in charge of hiring at TRW and you looked at these seven scores, you might logically ask, “Which of these scores is the best measure of Mary’s ‘true’ word-processing ability?” And more to the point, “Which is her ‘true’ score?”

The “true” answer to this question is that we cannot conclude with absolute certainty from the data we have exactly what Mary’s true word-processing ability is. We can, however, make an educated guess. Our educated guess would be that her true word-processing ability is equal to the mean of the distribution of her word-processing scores plus or minus a number of points accounted for by error in the measurement process. We do not know how many points are accounted for by error in the measurement process. The best we can do is estimate how much error entered into a particular test score.

The  standard error of measurement  is the tool used to estimate or infer the extent to which an observed score deviates from a true score. We may define the standard error of Page 170measurement as the standard deviation of a theoretically normal distribution of test scores obtained by one person on equivalent tests. Also known as the  standard error of a score  and denoted by the symbol σmeas, the standard error of measurement is an index of the extent to which one individual’s scores vary over tests presumed to be parallel. In accordance with the true score model, an obtained test score represents one point in the theoretical distribution of scores the testtaker could have obtained. But where on the continuum of possible scores is this obtained score? If the standard deviation for the distribution of test scores is known (or can be calculated) and if an estimate of the reliability of the test is known (or can be calculated), then an estimate of the standard error of a particular score (or, the standard error of measurement) can be determined by the following formula:

 

where σmeas is equal to the standard error of measurement, σ is equal to the standard deviation of test scores by the group of testtakers, and rxx is equal to the reliability coefficient of the test. The standard error of measurement allows us to estimate, with a specific level of confidence, the range in which the true score is likely to exist.

If, for example, a spelling test has a reliability coefficient of .84 and a standard deviation of 10, then

 

In order to use the standard error of measurement to estimate the range of the true score, we make an assumption: If the individual were to take a large number of equivalent tests, scores on those tests would tend to be normally distributed, with the individual’s true score as the mean. Because the standard error of measurement functions like a standard deviation in this context, we can use it to predict what would happen if an individual took additional equivalent tests:

· approximately 68% (actually, 68.26%) of the scores would be expected to occur within ±1σmeas of the true score;

· approximately 95% (actually, 95.44%) of the scores would be expected to occur within ±2σmeas of the true score;

· approximately 99% (actually, 99.74%) of the scores would be expected to occur within ±3σmeas of the true score.

Of course, we don’t know the true score for any individual testtaker, so we must estimate it. The best estimate available of the individual’s true score on the test is the test score already obtained. Thus, if a student achieved a score of 50 on one spelling test and if the test had a standard error of measurement of 4, then—using 50 as the point estimate—we can be:

· 68% (actually, 68.26%) confident that the true score falls within 50 ± 1σmeas (or between 46 and 54, including 46 and 54);

· 95% (actually, 95.44%) confident that the true score falls within 50 ± 2σmeas (or between 42 and 58, including 42 and 58);

· 99% (actually, 99.74%) confident that the true score falls within 50 ± 3σmeas (or between 38 and 62, including 38 and 62).

The standard error of measurement, like the reliability coefficient, is one way of expressing test reliability. If the standard deviation of a test is held constant, then the smaller the σmeas, the more reliable the test will be; as rxx increases, the σmeas decreases. For example, when a reliability coefficient equals .64 and σ equals 15, the standard error of measurement equals 9:

Page 171

With a reliability coefficient equal to .96 and σ still equal to 15, the standard error of measurement decreases to 3:

 

In practice, the standard error of measurement is most frequently used in the interpretation of individual test scores. For example, intelligence tests are given as part of the assessment of individuals for intellectual disability. One of the criteria for mental retardation is an IQ score of 70 or below (when the mean is 100 and the standard deviation is 15) on an individually administered intelligence test (American Psychiatric Association, 1994). One question that could be asked about these tests is how scores that are close to the cutoff value of 70 should be treated. Specifically, how high above 70 must a score be for us to conclude confidently that the individual is unlikely to be retarded? Is 72 clearly above the retarded range, so that if the person were to take a parallel form of the test, we could be confident that the second score would be above 70? What about a score of 75? A score of 79?

Useful in answering such questions is an estimate of the amount of error in an observed test score. The standard error of measurement provides such an estimate. Further, the standard error of measurement is useful in establishing what is called a  confidence interval : a range or band of test scores that is likely to contain the true score.

Consider an application of a confidence interval with one hypothetical measure of adult intelligence. The manual for the test provides a great deal of information relevant to the reliability of the test as a whole as well as more specific reliability-related information for each of its subtests. As reported in the manual, the standard deviation is 3 for the subtest scaled scores and 15 for IQ scores. Across all of the age groups in the normative sample, the average reliability coefficient for the Full Scale IQ (FSIQ) is .98, and the average standard error of measurement for the FSIQ is 2.3.

Knowing an individual testtaker’s FSIQ score and his or her age, we can calculate a confidence interval. For example, suppose a 22-year-old testtaker obtained a FSIQ of 75. The test user can be 95% confident that this testtaker’s true FSIQ falls in the range of 70 to 80. This is so because the 95% confidence interval is set by taking the observed score of 75, plus or minus 1.96, multiplied by the standard error of measurement. In the test manual we find that the standard error of measurement of the FSIQ for a 22-year-old testtaker is 2.37. With this information in hand, the 95% confidence interval is calculated as follows:

 

The calculated interval of 4.645 is rounded to the nearest whole number, 5. We can therefore be 95% confident that this testtaker’s true FSIQ on this particular test of intelligence lies somewhere in the range of the observed score of 75 plus or minus 5, or somewhere in the range of 70 to 80.

In the interest of increasing your SEM “comfort level,” consider the data presented in Table 5–5. These are SEMs for selected age ranges and selected types of IQ measurements as reported in the Technical Manual for the Stanford-Binet Intelligence Scales, fifth edition (SB5). When presenting these and related data, Roid (2003c, p. 65) noted: “Scores that are more precise and consistent have smaller differences between true and observed scores, resulting in lower SEMs.” Given this, just think: What hypotheses come to mind regarding SB5 IQ scores at ages 5, 10, 15, and 80+?

  Age (in years)
IQ Type 5 10 15 80+
Full Scale IQ 2.12 2.60 2.12 2.12
Nonverbal IQ 3.35 2.67 3.00 3.00
Verbal IQ 3.00 3.35 3.00 2.60
Abbreviated Battery IQ 4.24 5.20 4.50 3.00
Table 5–5

Standard Errors of Measurement of SB5 IQ Scores at Ages 5, 10, 15, and 80+

The standard error of measurement can be used to set the confidence interval for a particular score or to determine whether a score is significantly different from a criterion (such as the cutoff score of 70 described previously). But the standard error of measurement cannot be used to compare scores. So, how do test users compare scores?Page 172

The Standard Error of the Difference Between Two Scores

Error related to any of the number of possible variables operative in a testing situation can contribute to a change in a score achieved on the same test, or a parallel test, from one administration of the test to the next. The amount of error in a specific test score is embodied in the standard error of measurement. But scores can change from one testing to the next for reasons other than error.

True differences in the characteristic being measured can also affect test scores. These differences may be of great interest, as in the case of a personnel officer who must decide which of many applicants to hire. Indeed, such differences may be hoped for, as in the case of a psychotherapy researcher who hopes to prove the effectiveness of a particular approach to therapy. Comparisons between scores are made using the  standard error of the difference , a statistical measure that can aid a test user in determining how large a difference should be before it is considered statistically significant. As you are probably aware from your course in statistics, custom in the field of psychology dictates that if the probability is more than 5% that the difference occurred by chance, then, for all intents and purposes, it is presumed that there was no difference. A more rigorous standard is the 1% standard. Applying the 1% standard, no statistically significant difference would be deemed to exist unless the observed difference could have occurred by chance alone less than one time in a hundred.

The standard error of the difference between two scores can be the appropriate statistical tool to address three types of questions:

1. How did this individual’s performance on test 1 compare with his or her performance on test 2?

2. How did this individual’s performance on test 1 compare with someone else’s performance on test 1?

3. How did this individual’s performance on test 1 compare with someone else’s performance on test 2?

As you might have expected, when comparing scores achieved on the different tests, it is essential that the scores be converted to the same scale. The formula for the standard error of the difference between two scores is

 

where σdiff is the standard error of the difference between two scores, is the squared standard error of measurement for test 1, and is the squared standard error of measurement for test 2. If we substitute reliability coefficients for the standard errors of measurement of the separate scores, the formula becomes

Page 173

where r1 is the reliability coefficient of test 1, r2 is the reliability coefficient of test 2, and σ is the standard deviation. Note that both tests would have the same standard deviation because they must be on the same scale (or be converted to the same scale) before a comparison can be made.

The standard error of the difference between two scores will be larger than the standard error of measurement for either score alone because the former is affected by measurement error in both scores. This also makes good sense: If two scores each contain error such that in each case the true score could be higher or lower, then we would want the two scores to be further apart before we conclude that there is a significant difference between them.

The value obtained by calculating the standard error of the difference is used in much the same way as the standard error of the mean. If we wish to be 95% confident that the two scores are different, we would want them to be separated by 2 standard errors of the difference. A separation of only 1 standard error of the difference would give us 68% confidence that the two true scores are different.

As an illustration of the use of the standard error of the difference between two scores, consider the situation of a corporate personnel manager who is seeking a highly responsible person for the position of vice president of safety. The personnel officer in this hypothetical situation decides to use a new published test we will call the Safety-Mindedness Test (SMT) to screen applicants for the position. After placing an ad in the employment section of the local newspaper, the personnel officer tests 100 applicants for the position using the SMT. The personnel officer narrows the search for the vice president to the two highest scorers on the SMT: Moe, who scored 125, and Larry, who scored 134. Assuming the measured reliability of this test to be .92 and its standard deviation to be 14, should the personnel officer conclude that Larry performed significantly better than Moe? To answer this question, first calculate the standard error of the difference:

 

Note that in this application of the formula, the two test reliability coefficients are the same because the two scores being compared are derived from the same test.

What does this standard error of the difference mean? For any standard error of the difference, we can be:

· 68% confident that two scores differing by 1σdiff represent true score differences;

· 95% confident that two scores differing by 2σdiff represent true score differences;

· 99.7% confident that two scores differing by 3σdiff represent true score differences.

Applying this information to the standard error of the difference just computed for the SMT, we see that the personnel officer can be:

· 68% confident that two scores differing by 5.6 represent true score differences;

· 95% confident that two scores differing by 11.2 represent true score differences;

· 99.7% confident that two scores differing by 16.8 represent true score differences.

The difference between Larry’s and Moe’s scores is only 9 points, not a large enough difference for the personnel officer to conclude with 95% confidence that the two individuals have true scores that differ on this test. Stated another way: If Larry and Moe were to take a parallel form of the SMT, then the personnel officer could not be 95% confident that, at the next testing, Larry would again outperform Moe. The personnel officer in this example would have to resort to other means to decide whether Moe, Larry, or someone else would be the best candidate for the position (Curly has been patiently waiting in the wings).

JUST THINK . . .

With all of this talk about Moe, Larry, and Curly, please tell us that you have not forgotten about Mary. You know, Mary from the Cronbach quote on page 165—yes, that Mary. Should she get the job at TRW? If your instructor thinks it would be useful to do so, do the math before responding.

Page 174

As a postscript to the preceding example, suppose Larry got the job primarily on the basis of data from our hypothetical SMT. And let’s further suppose that it soon became all too clear that Larry was the hands-down absolute worst vice president of safety that the company had ever seen. Larry spent much of his time playing practical jokes on fellow corporate officers, and he spent many of his off-hours engaged in his favorite pastime, flagpole sitting. The personnel officer might then have very good reason to question how well the instrument called the Safety-Mindedness Test truly measured safety-mindedness. Or, to put it another way, the personnel officer might question the validity of the test. Not coincidentally, the subject of test validity is taken up in the next chapter.

Self-Assessment

Test your understanding of elements of this chapter by seeing if you can explain each of the following terms, expressions, and abbreviations:

· alternate forms

· alternate-forms reliability

· average proportional distance (APD)

· classical test theory (CTT)

· coefficient alpha

· coefficient of equivalence

· coefficient of generalizability

· coefficient of inter-scorer reliability

· coefficient of stability

· confidence interval

· content sampling

· criterion-referenced test

· decision study

· dichotomous test item

· discrimination

· domain sampling theory

· dynamic characteristic

· error variance

· estimate of inter-item consistency

· facet

· generalizability study

· generalizability theory

· heterogeneity

· homogeneity

· inflation of range/variance

· information function

· inter-item consistency

· internal consistency estimate of reliability

· inter-scorer reliability

· item response theory (IRT)

· item sampling

· Kuder–Richardson formula 20

· latent-trait theory

· measurement error

· odd-even reliability

· parallel forms

· parallel-forms reliability

· polytomous test item

· power test

· random error

· Rasch model

· reliability

· reliability coefficient

· replicability crisis

· restriction of range/variance

· Spearman–Brown formula

· speed test

· split-half reliability

· standard error of a score

· standard error of measurement

· standard error of the difference

· static characteristic

· systematic error

· test battery

· test-retest reliability

· transient error

· true score

· true variance

· universe

· universe score

· variance

 
Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

Case Study: Self Role As A Counselor For Feminist Therapy homework help

Case Study: Self Role As A Counselor For Feminist Therapy homework help

  • Understand the application of feminist therapy concepts to counseling.
  • Identify techniques commonly used in feminist therapy practice.

Directions: Assume the perspective of a feminist therapist, and show how you would proceed with Marina by answering the questions that follow the case description.

Marina: “Searching for Identity”

By Mary M. Read, PhD, Director of Clinical Training in the Counseling Department at California State University, Fullerton

Background

Marina is a 38-year-old single woman who came into therapy to better understand her emerging racial and sexual identities, as well as to cope with some issues surfacing from her traumatic childhood. She is having trouble keeping her job due to excessive tardiness. She links this to her “head feeling scattered” from new information she just received about her ethnic background and a budding attraction to women, when she had previously expressed herself as heterosexual. She admits to feeling “extremely down” at times, and she is struggling to incorporate conflicting views of herself on her own.

Feminist Therapy Approach from Dr. Read

Marina was referred to me by a coworker, specifically because of my feminist orientation to therapy. “I don’t want anyone to tell me what to do or how to be—I just want to get a handle on who I am so I can get on with my life,” Marina tells me in our first meeting. I assure her that we will explore her issues together, focusing on her strengths, and that she will be responsible for making the choices for her own life. She will be the expert on who she is and wants to become, and I will work to provide hope, encouragement, and support as she moves through this process. We discuss what feminism means in the context of therapy, and I leave plenty of time for Marina to ask me questions about my background, training, and therapy process, leveling the power differential between us somewhat.

Significantly, until recently Marina had been unaware that her father is African American. He left the family before she was 3 years old. Her mother’s family, of northern European descent, never shared with Marina why she did not have blonde hair and blue eyes like the rest of her family. Her brown hair, eyes, and café au lait skin tone matched others in her primarily Latino neighborhood, and she had assumed that her father was Hispanic. She has now met him once and finds that “a piece of the puzzle of who I am just fell into place,” yet some of the information he imparted is also very upsetting. Her father confirmed some of the memories Marina has about being verbally and physically abused by her mother and maternal aunt when she was very young, which progressed to sexual abuse when she reached puberty. Being sexually victimized by female relatives has made it very hard for Marina to explore her own sexuality, especially her developing realization of bisexual attractions.

Marina’s job is on the line, so we focus first on what it would take to please her boss (a woman) enough to successfully complete the remediation plan at work to salvage her job, then earn a better employee evaluation for the next period. This brings up Marina’s lack of sleep from frequent nightmares, resulting in missing her alarm once she finally returns to sleep. As well, Marina’s mood at work has been “grumpy and distracted” by her own admission. I ask if Marina has shared with her boss any of the extenuating circumstances that have caused a drop in her work performance, and she hasn’t. This brings up a choice point, where Marina could go along one path or another, disclosing personal information to her boss or not. Marina and I explore different avenues (mainly by role play and visualization) before she makes her selection, as part of informed consent. Understanding the risk-to-benefit ratio of her choices is part of what gives Marina the empowerment to make changes in her life.

I also encourage Marina to get a good physical from a medical doctor because she has been ignoring her health for some time. There are several female physicians to whom I routinely refer, and Marina agrees to make an appointment with one. The whole person is a focus of feminist therapy, and self-care is a vital tool of empowerment. We also discuss the possibility of seeing a psychiatrist if her depression worsens, or if her posttraumatic symptoms continue to interrupt her sleep. She is hesitant to follow through with this referral because, as she says, “I don’t want to be called crazy for what I remember.” I assure Marina that I do not see her as crazy, and that it is very common for children in abusive situations to develop coping skills that in the moment help them survive, yet in the long run also cause some problems.

Apparently, this has happened for Marina, who admits at our third meeting that she had seen a psychologist previously for a few sessions. “He gave me some tests, then said I was ‘Borderline,’ which sounded pretty hopeless, so I didn’t go back.” I explained to Marina that sometimes children who experience very early trust wounds, usually with their primary caregivers, later have difficulty figuring out who they are relative to others, and go back and forth on whether others are trustworthy or not. Given Marina’s complicated history with multiple losses and traumas, this pattern of development made sense. I encourage her to read books on the subject of surviving trauma in childhood, including John Briere’s Child Abuse and Trauma (Sage Publications, 1992), which talks about psychological symptoms as coping strategies that fit within the context of abuse. This feminist view of the diagnostic process allows for the development of better coping skills over time, emphasizing choice and empowerment versus abnormality and deficit. A strengths-based perspective, essential in feminist therapy, is thus preserved in the context of diagnosis.

Rather than see Marina through the lens of her diagnosis, she and I discuss how she is feeling about our relationship in each session. We make room for her to feel positively and negatively toward me, the therapy process, and the therapeutic relationship, not taking the feelings of the moment as the last word, but simply another layer of information to guide our work together. When she is angry with me, we explore what she might have wanted to be different, and whether that can be arranged, within the boundaries of therapy. For example, when I looked at the clock near the end of one session to be sure we ended on time, Marina came in the following session accusing me of being uncaring and wanting to be rid of her. Now, if I wonder about the time, I ask her where she thinks we are in the session, and we look at the clock together to gauge how to process where she is and where she’d like to be by session’s end. We both approach the end of the session differently now, and are learning from that shift.

To explore her emerging identities, I encourage Marina to participate in cultural events that provide a systemic context for her unique ways of being. She is becoming active in an African American singing and drumming group, wearing traditional African garb for performances. The rich cultural inheritance she now embraces helps her move from feeling “different” to “special,” which is increasing her self-esteem. I also encourage her to participate in events like Pride Festivals for the LGBT (Lesbian, Gay, Bisexual, and Transgender) communities, where many participants experience and express a sense of sexuality alternative to society’s hetero-normative views.

Embracing two identities that have been heavily stigmatized and oppressed over the years is a challenge for Marina because of society’s injustice rather than because of a deficit in Marina. She now realizes that her differences can be causes for celebration rather than discrimination, that social justice demands equality for all races and sexualities, and that finding her way in these alternative identities will take some navigating over time and in different contexts. Marina continues to use the support of feminist counseling to help her embrace her emerging identities and to explore ways to work for a more inclusive, tolerant society.

You Continue as the Therapist

(1) Marina decides to talk to her boss about why she has had issues being tardy (interrupted sleep), but she only discloses learning of her father’s ethnicity, not her child abuse history or shifting sense of sexuality. Marina reports that her boss responded by making a derogatory comment about African Americans. How would you process this with Marina? What are your responsibilities as a feminist counselor?

(2) Given that therapy is an intimate context, Marina begins to indicate she is experiencing feelings of attraction to you. How do you process this from a feminist perspective? How do you balance power-sharing with keeping appropriate therapeutic boundaries?

(3) Marina eventually loses her job, and with it the insurance coverage that paid for her therapy with you. As a feminist, how do you negotiate a new arrangement with Marina, ensuring she continues to receive needed support

answer the three questions and number responses only.

APA format

  • Margins – 1 Inch
  • Font – Times New Roman, Arial or Calibri (12pt)
  • Spacing – Double
  • Length – No Page Length (Questions must be answered thoroughly)
 
Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

Socw-6121-Responses Wk 2 homework help

Socw-6121-Responses Wk 2 homework help

***Each response needs to be ½ page or more with one reference***

RESPONSE 1

Respond to two colleagues who presented a different strength and/or solution in analyzing one of the levels of practice.

Colleague 1: Kevin

Micro-Level practice focuses on personal interaction with the client on an individual level or with a couple or family. The intervention of micro social work effects change on an individual basis and involves working closely with clients to support them through their challenges while maintaining the client’s self-determination (NASW, 2017).

Mezzo-Level intervention entails bringing people together who are not as intimate as a couple or group of family members but might mutually build and benefit from this social or resource network (Holosko, Dulmus & Sowers, 2012). It might directly change the system that is affecting a client, such as a classroom or neighborhood group. Mezzo work may include group therapy counseling, self-help groups or neighborhood community associations (NASW, 2017).

Macro-Level practice focuses on systemic issues. It might include creating and maintaining a network of service providers in order to establish a continuum of care. Macro-level intervention can intersect with the political realm by creating and lobbying for policy changes. The planning, implementation, and maintenance of social programs are also processes which macro-scale approach is applicable. Coordinating multiple services and policy work offers an opportunity to address several overlapping social problems (NASW, 2017).

Explain how you would assess Paula Cortez’s situation applying the micro-level of social work practice and specifically identify two strengths and/or solutions in this level

The student understands the essential concepts of Paula’s self-determination. Nevertheless, a micro-level approach could assist her through counseling, empathy, active listening, goal setting and building rapport with her to produce a healthy therapeutic relationship (Arendt, 2017). The directive for recognizing and focusing on Paula’s strengths is crucial to the committed client empowerment and fulfillment. Paula’s resilience was drawn from her cultural background that played a part in her independence especially from mainstream medicine. Also, Paula’s strengths were exhibited in her uniqueness in teaching herself how to paint with her non-dominant hand and her ability to gather professionals together to work with her (Cowger, 1994).

Describe how you would assess Paula Cortez’s situation applying the mezzo-level of social work practice and specifically identify two strengths and/or solutions in this level

The student would be non-judgmental and resourceful and use the mezzo-level approach when it comes to connecting Paula with the right referrals to assist her with preparation for the pregnancy (Plummer, Makris & Brocksen, 2014).The psychiatrist also was a supportive example of a mezzo interaction regarding Paula’s well-being during her pregnancy and worked with the social worker in making the hard decision of having Paula involuntarily admitted into the hospital (Plummer et al., 2014). Clearly, Paula’s resilience proceeds her, and it created a sense of purpose; a new beginning from what was a troublesome past filled with disappointment, emotional and physical abuse (Plummer et al., 2014).

Describe how you would assess Paula Cortez’s situation applying the macro-level of social work practice and specifically identify two strengths and/or solutions in this level

The student also recognizes that macro-level social work is essential in helping Paula to identify her personal needs. With advocating, the social worker can propose interventions and implement strategies through local government assistance, provided reasonable healthcare assistance, food and protected shelter that would aid Paula’s complex needs (Plummer et al., 2014).

Describe what the value of applying strength-based solutions is.

Applying strengths-based approaches will be helpful in successfully shifting the balance of care and developing services that are focused on prevention and independence. For example, Paula’s newborn child created that sense of purpose. Paula became independent and began to acquire social services on her own (Plummer et al., 2014). Paula maintained her autonomy which was of value to her.

References:

Arendt, V. (2017). Changing Areas of Practice: The Transferability of Social Work Skills. New Social Worker24(2), 10-25.

Cowger, C. (1994). Assessing client strengths: clinical assessment for client empowerment. Social Work39(3), 262-268.

Holosko, J., M., Dulmus, N., C., Sowers, M., K. (2012). Social Work Practice with Individuals and Families: Evidence-Informed Assessments and Interventions, 1st Edition. [Bookshelf Online]. Retrieved from https://bookshelf.vitalsource.com/#/books/9781118419359/

Plummer, S.-B., Makris, S., & Brocksen, S. M. (Eds.). (2014a). Sessions: case histories. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].

The National Association of Social Workers. (2017). Code of ethics. Retrieved from https://www.uaf.edu/socwork/student-information/checklist/(D)-NASW-Code-of-Ethics.pdf

Colleague 2: Lorraine

Your description of how micro-, mezzo-, or macro-levels of practice aid social workers in assessing families. Assess Paula Cortez’s situation using all three of these levels of practice, and identify two strengths and/or solutions in each of these levels.Assessing families is an important part of what we will do as social workers.

Understanding the family unit and how the intricate  parts of this unit interact and affect one another is essential.  On the Micro level it is important to understand each individual unit and the family’s dynamic.  This understanding of the family helps social workers identify how the  influences exist within the overall unit.  On a Mezzo level it is important to understand the families interaction as a group and the groups interaction with the community in which it lives and works.  The families access to resources and whether these resources are being utilized or not.  On a Macro level we examine how this family fits into the social environment on a larger scale and how social policies impact the family as a whole.  According to Holosko, Dulmus & Sowers (2013),  “The key challenge here is to recognize how the common themes of making available material and social resources and achieving health and well-being for all family members are constructed within the global economy and have different meanings across different contexts” (p.244).As I review Paula Cortez’s situation from a Micro level I can see several areas of strength.  However, the strengths I identify here have to do with Paul’s level of resiliency.  Paula has faced several life altering medical conditions, one being her HIV positive status.  Paula has been diagnosed as bipolar, yet has been able to remain out of the hospital of over 5 years.  On a  Mezzo level Paula has been admitted to a skilled nursing facility due to paralysis on her right side, yet has been able to progress within that facility and regain some mobility within her right arm and the ability to walk again.  Paula became pregnant and despite her overwhelming medical condition she has been able to request and receive 24/7 in home services for her child.  On a Macro level Paula is identified as low income.  Although Paula is part of a larger issue regarding poverty and the imbalance of societal wealth,  she is doing her best to utilize public assistance to help her in providing a stable environment for her self and her child.  Paula is utilizing many social resources to assist her with her childcare as well as her health issues (Plummer, Makris & Brocksen, 2013).

Describe the value in strength-based solutions.

I am a overwhelming fan of strength based solutions.  Strength based solutions provide he client with a strong focus on their abilities and on what can be done as opposed to what can’t.  There are key themes social workers should incorporate when assessing families.  According to Holosko, Dulmus & Sowers (2013), “A commitment to the belief that families bring strengths and resources to the helping relationship, and these can be harnessed in finding solutions. This means that the assessment can provide opportunities for exploring both problems and resources within the family” (p.247).  It is important for clients to focus on the genuine possibilities and work towards realistic, measurable and obtainable goals.  When clients are operating from a strengths perspective, they can begin to envision their goals as actual possibilities.  Operating from a strength perspective does not discount the serious nature of the families issues at hand, it incorporates the understanding of the risk involved with the family’s situation while incorporating a strength based approach to it.  According to  Holosko, Dulmus & Sowers (2013), “An understanding that a focus on strengths does not diminish the importance of identifying risk and safety issues and finding ways to protect clients from harm and causing harm” (p.247).

Holosko, M. J., Dulmus, C. N., & Sowers, K. M. (2013). Social work practice with individuals and families: Evidence-informed assessments and interventions. Hoboken, NJ: John Wiley & Sons, Inc. Chapter 9, “Assessment of Families” (pp. 237–264)

Plummer, S.-B., Makris, S., & Brocksen, S. (Eds.). (2013). Sessions case histories. Baltimore, MD: Laureate International Universities Publishing. “The Cortez Family” (pp. 23–25)

RESPONSE 2

Respond to two colleagues whose assessments of family cohesion differ from yours. Resolve the differences or explain how each viewpoint is valid.

Colleague 1: Farren

The Circumplex Model of Marital and Family Systems is a tool that is used when working with families. The models address three dimensions which are cohesion, flexibility, and communication (Olson, 2000). The model is designed for treatment planning and clinical assessments and focuses on treating marital and family system and focuses on togetherness (Olson, 2000). The goal of this model is to promote flexibility and provide balance amongst the members and create ways to effectively communicate.

The Cortez family would benefit from the Circumplex Model as they appear to lack togetherness and everyone appears to be doing their own separate things. The family would benefit from cohesion as it balances togetherness as the family appears to be very distant from one another (Plummer, Makris, & Brocksen, 2013). Balanced families have better communication skills than unbalanced families (Olson,2000). The Circumplex model would also assess the family’s flexibility as it would assess how the family reacts to change. In the Cortez family, Paula is pregnant and has numerous health issues, and the father had remarried and Miguel was in school and had a job. The family system appears chaotic and the family is distant and has their own lives, however, Miguel did step in and provide some support but it was limited (Plummer, Makris, & Brocksen, 2013). Communication reinforces the previous 2 dimensions (Olson, 2000). In the Cortez family, it does not appear that there is effective communication going on however, Paula and Miguel appear to communicate more together then they do with David.

Assessing these dimensions can assist the social worker in treatment planning as it can help the social worker create goals by assessing the gaps in the family dynamics. In the Cortez case communication amongst the family members appears to be very limited. Also, the family lacks cohesion. The Circumplex Model would have identified these issues and create goals that will alleviate some of the family’s issues if they are able to successfully achieve their goals as the model is designed for clinical assessment and treatment planning (Olson, 2000).

Reference

Olson, D. H. (2000). Circumplex Model of Marital and Family Systems. Journal of Family Therapy, 22(2), 144–167.  Note: You will access this article from the Walden Library databases.

Plummer, S.-B., Makris, S., & Brocksen, S. (Eds.). (2013). Sessions case histories. Baltimore, MD: Laureate International Universities Publishing. “The Cortez Family” (pp. 23–25)

Colleague 2: Amanda

The circumplex model of families and relationships are built on three different dimensions. These dimensions include cohesion, flexibility, and communication (Olson, 2000). Each of these dimensions are broken down to show us how a family functions. Cohesion is described as the amount of time the family spends together as a whole. There are four types of cohesions that could be possible within a family unit, disengaged, separated, connected, and enmeshed (Olson, 2000). Disengaged is the lowest form of togetherness while enmeshed is overly together. Flexibility is like cohesion, but this shows amount of change in its leadership, role relationships, and relationship rules (Olson, 2000). The levels of flexibility include rigid, which is the lowest, structured, flexible, and chaotic, which is the highest level (Olson, 2000). If there is no conformity or leadership within a family unit, there will indeed be chaos. Communication is different and has many different aspects to it. This is when the family unit can communicate with regards to their listening skills, speaking skills, self-disclosure, clarity, continuity tracking, respect, and regard (Olson, 2000). The circumplex model serves as a framework to assess family systems, because each dimension helps you to identify to what degree the family is suffering.

The Cortez family case is slightly complicated. This family unit includes Paula (mother), Miguel (son), and David (father). This family no longer live together as a family due to Paula’s illnesses, however they are still close to one another (Plummer, Makris, & Brocksen, 2013). In the first dimension of the circumplex cohesion, Paula’s family tends to be disengaged. I say disengaged, because David and Miguel are doing their own thing with limited attachment or commitment to Paula (Olson, 2000). The second dimension is flexibility. Paula’s relationship with her son Miguel is chaotic. I chose chaotic because there is no leadership between them, nor is there proper decision making. Paula is constantly going off her medications making her impulsive (Plummer, Makris, & Brocksen, 2000). The last dimension is communication. Paula has poor communication within her family unit. She doesn’t ask for help when needed, and she rarely speaks with Miguel or David unless she must.

Assessing these dimensions helps the social worker in treatment planning, because to set goals and help family units, we must know how the family is functioning daily. This can also help with the breakdown of what maybe causing some family problems. Treatment plans are vital to clients who are struggling to keep their family together such as a separation or divorce. Its helpful to the social worker to set goals, and if these goals are followed than there is a chance the family unit can change, if the goals are not followed than the chance of a change is slim.

References:

Olson, D. H. (2000). Circumplex Model of Marital and Family Systems. Journal of Family Therapy, 22(2), 144–167.

Plummer, S.-B., Makris, S., & Brocksen, S. (Eds.). (2013). Sessions case histories. Baltimore, MD: Laureate International Universities Publishing.

 
Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

ethical_standards homework help

ethical_standards homework help

Feedback from professor below:

Now, keep moving in this direction. The synthesis and flow of your posts need to be improved upon. All references need to be clearly integrated into your personal perspective. I need to see you use the references as an integrative piece of your posts instead of a standalone piece. We are still working on that analytical piece as discussed in previous dialogue work.

I still need to see more of the application piece I continue to reflect about. Your reference use should be more about how you are analytically reflecting about the research. You are continuing to improve in this area. I encourage you to just continue to work on the application piece of how you are expanding on the authoritative voice used in your posts or your classmates posts.

Topic: Search the web for ethical standards in the Human Services field, then find at least 5 Scriptures describing how we should treat others and care for them. Compare and contrast the Human Service ethics standards with biblical standards. How are they alike? How are they different?  Reply to 3 of your classmates’ threads from the last module/week. Each reply must be at least 150 words and meaningfully expand the discussion. I have 4 below, reply to 3 of the 4. With references!! Thank you.

1. Reply Ra K.

Ethical standards are used as guidelines between the social worker and client.  The guidelines are use to help the client get the most out of their meeting with their social worker. With looking at ethical standards, God is at the center point of putting these in places because He wants to protect His children.  As we go deeper into ethical standards we need to look at them the way God wants us to look at them through scripture.  As we look at the scripture we need to see how different or similar the standards are with the scriptures.

The first ethical standard that needs to be discussed is confidentiality.  Proverbs 26:20-22 states that as a social worker we need to keep things clients tell us to ourselves to keep from having altercations.  As a social worker keeping confidentiality will help your client open up to you more when things that occur in their life are terrible.  Having the trust will help the fire from burning between you and your client.  As in the bible, we do not want to gossip, and this plays a role in being a social worker because no social worker should tell another social worker anything about a client, unless the client

allows the information to be said to other social workers, otherwise harm will come to the client or a person a client knows.  As a social worker, having an understanding of your client is knowing when to be quiet and not gossip about their client (Proverbs 11:12-13).  One thing that is different with confidentiality based on the scriptures is that gossip does happen within the Christian community, and as a social worker it cannot, because of the rules set in the ethics of confidentiality (Psalms 41:6).

The ethical standard that needs to be discussed is to provide services to the client having the right boundaries.  While not following the boundaries within the scope of practice for social work is not counting the cost of what could happen to the social worker going outside of their boundaries (Luke 14:28).  As a social worker you need to look at what you can offer and not be foolish and go outside your scope of practice (Luke 12:28-32).  One difference is God can go outside His scope of practice to do anything, because he is perfect, and as a social worker you cannot go outside your scope because you can lose your job, due to because of the boundaries set in place to protect clients within the standards of ethics (Psalm 18:30).

The ethical standard that needs to be discussed is to treat everyone with worth no matter what culture they have come from or where they are in life. Everyone has a purpose and a reason to be here because they are made in Gods image (1 Corinthians 12:12-14).  There are no small parts; everyone needs be seen as one in humanity.  As social workers we need to look at our clients through God’s eye instead of looking at our out clients through the eyes of a man, because everyone in this world has a purpose (1 Corinthians 12:15-26).  The difference between scripture and the standards of ethics is that people will look through the eye of man to judge people that come from different cultures.

The ethical standard that needs to be discussed is that the social worker and client should not have any sexual contact. (1 Thessalonians 4:3-4), God wants you to away from having sex unless it with your married partner.  As a social worker you should not lust about your client, or want to have any sexual relations with that client (1 Thessalonians 4:5).  That means you should never take advantage of your client in any possible way (1 Thessalonians 4:6).  A social worker who has a relationship with Jesus and does not want to stay clean is rejecting God “who has given us His Holy Spirit” (1 Thessalonians 4:7-8).  There is not real difference between scripture and ethical standards when it comes to sexual contact.

The ethical standard that needs to be discussed with a client is when it is time to terminate the services for the client. It states that in the presence of the social worker, the client is doing the work.  When not in the presence of the social worker they are still working on their goals outside of the office in their daily life (Philippians 2:12-13).  Then the social worker states, you have come as far as you can and you are ready to be done with working with me.  You are ready to keep continuing with God at your side. The difference in the standards of ethics with termination is that when the client is done working with the social worker, God will keep guiding them in the right direction for their future.

References

Code of Ethics of the National Association of Social Workers.  (2014).  Retrieved

September 18, 2014, from, http://www.socialworkers . org/pubs/code/code.

asp

The Life Application Study Bible is an edition of the Holy Bible, New Living

Translation.  (2nd ed.).  (2004).  Carol Stream, IL: Tyndale House Publishers, Inc.

2 Reply

Ter Y The Human Service field is one that requires contact with a wide variety of people with a vast array of problems.  Handling each and every situation/client requires the human service worker to be able to provide proper treatment in regards to dignity, respect and have the client’s welfare top priority.  The human service worker should also hold themselves in the same manner as his/her client, “And just as you want men to do to you, you also do to them like-wise” (Luke 6:31).  They should hold the upmost dignity, and respect while maintaining their integrity in each situation.

Providing a professional relationship should be the only relationship a human service worker is engaged in with each client.  Protecting each client’s right to his/her privacy and confidentiality should also be adhered too.  However, in the instance that withholding information might cause the client or someone else harm, that privacy and confidentiality should be handled in an appropriate manner to ensure the safety of all involved.  The files of the client should also be handled in a confidential manner, with respect to the integrity and safety of the client.

The client should be informed of his/her rights to receive or refuse service, “For each one shall bear his own load” (Galatians 6:5), and understand those rights will be protected. They should also be made aware of the nature of the worker-client relationship with the limits of that relationship and the goals.  The limits of confidentiality and the reason to break confidentiality should also be discussed in the beginning of the worker-client relationship. The human service worker should understand recognize the strengths of the client and use those strengths in a manner to reach the goals set, “Let no corrupt word proceed out of your mouth, but what is good for necessary edification, that it may impart grace to the hearers(Ephesians 4:29).  They should work to not put down the client, but to build them up in order for them to be able to succeed and rise above their current life predicament.

These guidelines that have been outlined by the National Organization of Human Services (2014), are standards that should be upheld to the highest by each human service worker.  Each client is unique in his/her own way and by offering him/her with the highest degree of professionalism with regards to these ethical standards it the right each one holds.

Galatians 3:28 tells us that we are all children of God, and should not be discriminated against because of race, life predicament, or sex.  Just as a worker for a human service agency should view each client as an individual and allow them the freedom of discrimination, as “God shows no partiality” (Acts 10:34), neither should they.  Just as a client should be treated with dignity and respect, Titus 2:7 talks about how we should act as a model of integrity and dignity.

Confidentiality and Privacy not only protects the client’s information and safety, it shows the client that they can trust the human service worker and not have to worry about their situation being thrown out in the open for all to know.  Proverbs 11:12-14 is similar to this in telling us to be understanding of one’s privacy and not break that confidentiality.  This gains respect for the human service worker as well. The ethical code of confidentiality is a very important aspect of the human service-client relationship.  It is not only demanded of the relationship, it gives the client the security to know that his/her situation can be dealt with privately and the fear of their situation being heard on the streets is diminished.

As important as it is to uphold the dignity and integrity of the client, the human service worker must also be concerned with their own integrity.  If they are not a trustworthy person and cannot uphold the code of ethics for the client, then how can the client trust them to help them out of their situation? “Confidence in an unfaithful man in time of trouble Is like a bad tooth and a foot out of joint” (Proverbs 25:19). This verse sums it all up pretty well, if a human service worker is supposed to be a helpful link to a way out of a problem and they cannot be trusted, then the client is only going to be handed more problems.

The Bible and the Human Service Ethics both focus on how to treat human beings with the respect, dignity, upholding his/her integrity and providing the freedom of receiving services without being discriminated against.  Helping people in their time of trouble is not only the job of a human service worker, but can also be a rewarding experience, “Therefore comfort each other and edify one another, just as you also are doing” (1 Thessalonians 5:11), Working with people in need can be as uplifting and inspiring to the human service worker as it is to the client. Having ethical standards that are set in place to protect the client as well as the human service worker allows both parties to be insured that the dignity, integrity and respect of both parties will be protected.

When working in the human service field, we all have our own beliefs and values and desire to help those in immediate need. Working in the human service field requires a person to not only follow the code of ethics, but to also understand how having their own religious values and beliefs plays a huge role in how they view those they are helping.  I feel that the Bible works hand in hand with the code of ethics, and the only difference I found was that when it talked about relationships, it did not mention professional relationships.  Whether it is mentioned in the Bible about a professional relationship, or normal relationship, I still feel the Bible is compatible with the code of ethics.  I know from experience it has been my faith that has carried me through many days of working with those in need.

References

Ethical Standards for Human Service Professionals (2014). Retrieved September 15, 2014, from http://www.nationalhumanservices.org/ethical-standards-for-hs-professionals

New King James Version (1982). Thomas Nelson, Inc.

3 Reply

P.A.

Today in the Human Services field many secular professionals should uphold a high standards with their clients. Likewise, Christians should uphold an even higher standards with their clients. Rather, a Christian or a secular professional it is imperative to treat each client with the upmost respect. There are many job requirements to follow as a secular professional, but if the secular professionals do not have Christian values they will not fully follow them.

There are several ethical statements that Human Services Professional should follow.  One statement states “human service professionals negotiate with clients the purpose, goals, and nature of the helping relationship prior to its onset.” (National, 2014)  As a human service professional it is mandated to obtain information for the clients that in order to better assist them with their progression. Similar, Christian professionals will do the same thing, but they will perform at the best of their abilities and do it unto the Lord. The scripture says, “Whatever you do, work heartily, as for the Lord and not for men, Colossians 3:23.” This ethical statement is similar to the biblical standard because they both are going to be diligent in getting all information needed to do their job effectively and help better assist their client.

Another statement states “human service professionals respect the integrity and welfare of the client at all times.”(National, 2014) This statement requires that the professional be honest and have the client’s best interest at heart. It is vital that as a human services professional their actions speak louder than their words, so that, a client can trust the professional. 1 John 3:18 ESV says “Little children, let us not love in word or talk but in deed and in truth.” Similar, feign love is when a human service professional can pretend to have the client’s best interest at heart, and not really love nor respect them.

Thirdly, “human service professionals protects the client’s right to privacy and confidentiality.” (National, 2014) Professionals in the human services field are tasked with a great responsibility of making sure information that is given by a client is kept between the two of them. No matter who tries to get the information, it is against the policy of most companies to ensure the client’s confidentiality. The comparison between a Christian professional and a regular professional is a Christian professional is more willing to honor his or her word, such as, a vow made to God. The professional may tend to give out information to a co-worker without thinking.  In fact, both the secular professional and the Christian is governed by law to never freely give out any information concerning a client without the client’s permission. Proverbs 11:13 (NIV) says “A gossip betrays a confidence, but a trustworthy person keeps a secret.”

The fourth statement states “the human service professional acts in an appropriate and professional manner to protect the safety of those individuals.” (National, 2014) A human service professional has been given the authority to protect their clients from all bad counsel same as the Christian.  Proverbs 11: 14 (NKJV) says, “Where there is no counsel, the people fall; But in the multitude of counselors there is safety.” If a counselor gives a client useful information that clients is more susceptible to take the right path and recover from a major trauma in their life.

Lastly, the seventeenth statement states, “Human service professionals provide services without discrimination or preference.”(National, 2014) Similar, the Christian professional belief is that his God rains on the just as well as the unjust, Matthew 5:25, thus clarifying that his services are without discrimination or preference. It is important to note that there are several ethical statements that Human Services Professionals should follow. Even though one maybe a secular professional or a Christian professional because Christ died for all, this is the most important statement.

Reference

National Organization for Human Services (2014). Ethical Standards for Human Service Professionals. Retrieved from http://www.nationalhumanservices.org/ethical-standards-for-hs-professionals

4 Reply

Br P

Working in the Human Services field is for those who wish to help others live better lives. In order to do this, those who work in this field must have some ethical standards to follow and these standards can also be applied biblically in how to treat others. Luke 6:31 (ESV) says, “And as you wish that others would do to you, do so to them.” This verse can be applied to the ethical standards set forth by the National Organization for Human Services regarding the professional’s responsibility to clients. Specifically, it can be applied to statement number 2 that says, “Human service professionals respect the integrity and welfare of the client at all times. Each client is treated with respect, acceptance and dignity,” (National Organization for Human Services, n.d.). This can be a problem if by some strange chance someone in this profession does not want to be treated with something like acceptance, thus not treating the client with acceptance, respect, etc. Another verse that may be applied to this statement of ethical standards is John 15:12; “This is my commandment, that you love one another as I have loved you,” (ESV). While this is a wonderful verse to keep in mind and apply when dealing with others, Human Services professionals still need to maintain some kind of boundaries with clients as to not cross over the professional/client relationship. This issue is addressed in Statement 6 of the ethical standards which mentions the unequal roles of the client and the helping professional.

I think one verse that is crucial to remember when working with others is Philippians 2:4 which states, “Let each of you look not only to his own interests, but also to the interests of others,” (ESV). This is probably one of the most applicable Bible verses to remember in the Human Services profession – particularly Statement 9 of the ethical standards that suggests building on a client’s strengths and not our own. Philippians 2:3 is also a good verse to apply here; “Do nothing from rivalry or conceit, but in humility count others more significant than yourselves,” (ESV). It is important to remember you are responsible for helping someone else in dealing with something they feel they are not capable of on their own. If you are more concerned with your lunch break or something at home than the person you are helping, then you may not be doing your job.

Statement number 14 says, “Human service professionals represent their qualifications to the public accurately,” (National Organization for Human Services, n.d.). Being honest is not only an ethical standard to uphold in the Human Services profession, but also as a child of Christ. “Truthful lips endure forever, but a lying tongue is but for a moment,” (Proverbs 12:19, ESV). Someone may want to make themselves look better by lying about their credentials, and it may make someone feel more comfortable about using you as help for the time-being, but it is more harmful in the end because the person who has lied does not have the training or knowledge to truly help those that come to them.

 

References

Holy Bible, ESV

Unknown. (n.d.). Ethical Standards for Human Services Professionals. National    Organization   of Human Services Professionals. Retrieved September 21, 2014, from             http://www.nationalhumanservices.org/ethical-standards-for-hs-professionals.

 
Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

100 MCQs Of Psychology homework help

100 MCQs Of Psychology homework help

Multiple Choice Questions (Enter your answers on the enclose ed answer sheet)

1.When there is a discussion of “theory” as related to judgments of right and wrong the discussion is probably one of:

b.philosophical morality

c.professional ethics

d.philosophical ethics

e.common morality

f.both band d

2.Which of the following is NOT listed in your text as part of the professional structure which governs ethics for counselors?

a.the courts

b.colleges and universities

c.professional organizations that maintain and enforce a mandatory code of ethics

d.professional regulatory bodies that are enforcers of mandatory codes

e.none of the above

3.The BEST place to find up-to-date information of currently accepted ethical practice in the field is:

a.counseling journals

b.the Internet

c.state I icense boards

d.graduate level textbooks

e.all of the above

4. can be defined as: the extent and limits of activities considered acceptable by individuals licensed or certified in a profession or specialty.

a.Scope of practice

b.Malpractice

c.Accreditation

d.none of the above

5. Which of the following is the accrediting body for professional counseling?

 

a. AMA

b. AAMFT

c. NASW

d. ACA

e. CACREP

 

6. The oldest established mental health profession is:

a.psychiatry

b.social work

c.marriage and fam i Iy therapy

d.psychiatric nursing

e.psychotherapy

7.Which of the following degrees does NOT indicate legitimate doctoral level training to be a Iicensed Psychologist?

 

a. Ph.D.

b. Ed.D.

c. M.D.

d. Psy.D

8. Which professional organization represents marriage and family therapists?

 

a. ACA

b. AAMFT

c. APA

d. ABPS

e. none of the above

9.Which professional(s) can NOT legitimately, by nature of standard training and practice, perform psychometric assessment?

a.marriage and fam i Iy therapist

b.counselor

c.psychologist

d.social worker

e.none of the above

10. The ABPP and ASPS credential applies to which field of mental health specialty?

a.Marriage and family therapy

b.Social work

c.Psych iatry

d.Psychiatric nursing

e.none of the above

h.

 

1l. Informed consent generally requires that the counselor should reveal to the client information about:

a.the counselor’s credentials or training.

b.alternative treatments.

c.the potential benefits or detriments of treatment.

d.all of the above

12. A counselor’s primary responsibility is to the:

a.third party referral source.

b.judge who subpoenas a case file.

c.family of a competent adult client seen in individual counseling.

d.professional setting (employer) where the counselor works.

e.none of the above

13. Which of the following IS FALSE?

a.The primary responsibility of the counselor is to the referral source.

b.Nonprofessional counselor-cl ient relationshi ps shou Id be avoided when possi ble.

c.Services must be fully described and explained to clients before they consent to treatment.

d.Sexual intimacy with clients is unethical.

 

14. Professional competence by definition involves:

a.the quality of provided services

b.informed consent

c.confidentiality

d.boundaries of professional activity

e.both a and d

15. Which of the following statements is TRUE?

a.Counselors can ethically practice any specialty in counseling, even without appropriate

specialty training, if it is within the scope of practice of their license.

b.Cottone and Tarvydas believe the terms “dual” and “multiple” relationships should be abandoned.

c.Avoiding detrimental relationships with clients relates to the ethical principle of justice more than non maleficence.

d.People who refuse recommended counseling services must be coerced.

i.

 

16.When a judge orders an ex offender to undergo therapy as part of the ex offender’s rehabilitation, this is called:

a.expert order of protection

b.legal privilege

c.professional responsibi I ity

d.compulsory therapy

17.The Supreme Court decision in Jaffee v. Redmond provided what type of assistance to psychotherapists in federal court cases?

a.eliminated their responsibility to testify as expert witnesses

b.upheld their abi I ity to mai ntain confidential information through assertion of legal privi-

lege

c.eliminated their ability to assert privilege in communication with clients

d.instructed counselors that privi lege only exists between attorneys and their cl ients, not

between counselors and their clients

18.Which of the following is an example of special circumstances that counselors may be faced with in relation to confidentiality and privilege?

a.counseling persons with HIV/AIDS

b.family/couples counseling

c.clients in drug/alcohol treatment

d.all of the above

 

19.An exception to confidentiality for psychologists and counselors serving in the military exists and focuses on which area most clearly?

a.responsi bi I ity to report generally negative attitudes of officers and enl isted personnel

b.report threats to military installations, weapons and integrity even when threats to specific persons have not been made

c.to report all counseling activities regardless of the content to their superiors on a regular basis

d.none of the above

20.According to Welch (2003), one of the most common types of malpractice liability in treatment services for mental health professionals is:

a.fraudulent billing

b.family treatment and forensic situations

c.dual relationships

d.group counseling

 

21.According to Arthur and Swanson (1993). clinical records should be written to include which of the followi ng?

a.clear objective statements with behavioral descriptions

b.professional terminology not easily interpreted by legal counsel

c.jargon that does not clearly specify behavioral outcomes

d.little objective information; subjective thoughts of the counselor are of most importance

22.When assessing a client’s potential for harm, Beauchamp and Childress recommend the counselor assess primarily which elements?

a.probabi I ity of harm

b.magnitude of harm

c.physical vs. psychological nature of harm

d.both a and b are correct

23. Counselor values tend to determine the of counseling.

a.content

b.process

c.level of professional ism

d.lack of progress

24. Client values determine the of counseling.

a.process

b.level of progress

c.content

d.all of the above

25.Objectively applying a system of ethical rules and principles that a counselor may use to determine a right or moral decision about an ethical dilemma would be considered _

a.ethics of caring

b.virtue ethics

c.principle ethics

d.none of the above

k.

 

 

Multiple Choice Questions (Enter your answers on the enclosed answer sheet)

1.Why is practice in solving mock ethical dilemmas, as well as working to address actual dilemmas under supervision of an educator or experienced clinician important?

a.Because ethical decision making skills are very easily learned.

b.Ethical situations happen infrequently and counselors shouldn’t worry so much about them.

c.Ethical decision making skills do not come automatically or easily and require practice, supervision and diligence in learning.

d.Because you will never be able to come up with the “correct” answer.

2.The ethical decision-making model introduced by Cottone is based upon what theoretical model?

a.general psychologically based models

b.post-positivism

c.social constructivism

d.none of the above

3. What does social constructivism mean to ethical decision making?

a.Decisions cannot be viewed as occurring internally (by an individual in isolation).

b.Decisions must be selected by the counselor weighing internal feelings and cognitions.

c.Decisions are best when made by a single individual.

d.Counselors must deliberate over a decision for a lengthy period of time.

4.Ethical decision making models often provide a series of steps for making an ethical choice, however they may fail to describe which of the following:

a.the consequences that can occur when an ineffective course of action is taken

b.how the choice in a specific course of action occurs (an exploratory framework for the decision process itself)

c.how values are weighed by the decision maker

d.a II of the above are correct

5.In the social constructivism model, the decision to breach an ethical standard or a challenge to a counselor’s professional ethics is a decision that is derived from past and present interactions. Which of the following forces come into play in this situation?

a.biological and social forces that affect interactions in one way or the other

b.biological forces

c.social forces

d.psychological determinants

m.

6.According to the social constructivism process in ethical decision making, when consensualizing fails, then parties may engage in reflective interaction to accomplish:

a.an agreement on the decision to be made

b.to determine whether arbitration should be undertaken

c.be able to make the decision on their own

d.to hold firm to their original position

7. Cottone’s model of ethical decision making is based on:

a.purely social-relational theory

b.purely relational model

c.ethical principles

d.psychologically-based ethical decision making

8.When colleagues engage in bullying, harassment, or emotional abuse of an individual within the workplace, this would be described as:

a.a normal difference of opinion that occasionally occurs within a workplace

b.a case of mobbing within an organizational culture

c.relational issues that are normal when people work closely with one another

d.individuals who are experiencing conflict due to holding similar values

9. Which of the following characteristics may place a work environment at risk for mobbing?

a.having more staff than is necessary (overstaffing)

b.increased stress in the workplace

c.unethical activities

d.both band c are correct

10.Several states have acknowledged that mental injury can result from excessive stress on the job and this phenomenon has been called:

a.mental health injury

b.overstress syndrome

c.organizational mental injury

d.occupational mental injury

n.

11. Wh ich of the following may happen to a counselor that assumes the role of a “whistleblower”?

a.mobbing

b.mixed support from superiors and administration

c.potential life changing experience and increased stress

d.all of the above

12.At present there are several corporations that are establishing company policies that support an individual’s right to be employed in an environment that is free from mobbing.

a.True, this is happening at present.

b.False that is something for the future.

c.False, it would never work.

d.none of the above are correct

13.The way people would characterize a system’s general practices and procedures, such as the sense of safety or fear or retribution that a counselor may feel when faced with big or small decisions within this context would be described as?

a.climate

b.ethical climate

c.organizational climate

d.none of the above

14.To provide a service outside of the realm of medical psychotherapy and then bill it as medical psychotherapy is an example of:

a.sliding fee scales

b.fraudulent billing

c.double billing

d.all of the above

15. Pro bono publico refers to what?

a.Working as a counselor for the state, or county and serving the general public.

b.Being an expert witness at a criminal trial.

c.A Spanish speaking Counselor or Therapist.

d.none of the above

o.

 

16.This term describes when a diagnosis is more severe than diagnostically justified to ensure adequate insurance payment for the anticipated treatments.

a.double billing

b.overdiagnosis

c.fraudulent diagnostics

d.embellishment diagnostics

e.none of the above

17.It is standard practice to destroy case records generally years after services have

been terminated.

a.10-12

b.2-4

c.5-7

d.none of the above- by law case records are never to be destroyed.

18. Areas of major ethical concern in working with people with HIV include:

a.confidentiality

b.informed consent

c.stigma

d.both a and b are correct

19.The Rehabilitation Act of 1973 and the Americans with Disabilities Act do Which of the following for individuals diagnosed with HIV/AIDS?

a.protect individuals who are diagnosed with HIVIAIDS from undue discrimination

b.do not protect individuals with HIV/AIDS from undue discrimination

c.protect only individuals with HIV from undue discrimination

d.protect only individuals with AIDS from undue discrimination

20.The Tarasoff outcome directs the counselor in which of the following actions when considering the safety of a th ird party?

a.counselors are not responsible for warning third parties they may be in danger

b.counselors have a responsibility for third parties that they know may be in danger

c.cannot breach confidentiality no matter what the situation

d.may breach confidentiality only when suicide is involved

p.

 

2l. Regarding the ethical issues surrounding complimentary and alternative medicine, which of the following statements is true?

a.The current status quo does not include a “don’t ask/don’t tell” approach.

b.CAM advocates may be denying the role of traditional medicine.

c.Managed care typically never reimburses for CAMs.

d.I ndividuals who choose CAMs as a treatment forfeit their right to autonomy.

22. What percentage of Americans feel that abortion should be legal in some form?

a.25

b.45

c.70

d.90

23.A type of test administration that especially does not transfer well to computerized assessment is:

a.vocational interest testing

b.aptitude testing

c.neuropsychological testing

d.personality testing

24. An ethical concern in the area of distance education at present is:

a.lack of an outcome research base comparing traditional and distance education methods

b.it has been proven that distance education lacks program integrity

c.grades which are granted for courses

d.none of the above are correct answers

25.The most frequent strategies that unethical practitioners use to get around the ethical

standards that exist in the area of web counseling are:

a.not holding membership in professional organizations that create standards that

are enforceable

b.using unregulated titles or service descriptions to elude regulatory authorities

c.not charging a fee for web counseling services

d.both a and b are correct answers

 

 

Multiple Choice Questions (Enter your answers on the enclosed answer sheet)

1.Counselors should critically examine current ethical codes focusing on multiculturalism to

address which of the following?

a.cultural bias and encapsulation

b.professional self regulation and lack of measurable multicultural accountability

c.favoritism toward the dominant culture

d.all of the above

2.These terms are outdated and possibly harmful concepts, but were previously used in

counselor training programs several decades ago.

a.cu Itural deficit

b.race

c.cu Iturally disadvantaged

d.a and conly

e.all of the above

3.The tendency to treat others relative to one’s own cu Itural perspective with an apparent disregard for cultural differences is called:

a.cultural encapsulation

b.cultural deficit

c.multiculturalism

d.none of the above

4.As a third generation Japanese American counselor in a downtown mental health center that

serves a primarily African American population you are frequently involved in helping

relationships with individuals who have a socially constructed worldview that differs from your

own. You would be providing this type of counseling:

 

a. conservative

b. transcultural.

c. client centered

d. primary

e. cross cultural

5.To educate culturally competent practitioners entering the field, educational programs should

strongly consider uti I izi ng the best approach of:

a.

b.

c.

d.

e.

186

 

 

offering a course on racism and infusing culturally sensitive content throughout the

curriculum

offering a course on multiculturalism

not concerning themselves with culture and multicultural competencies

making sure students have exceptional knowledge of the professional code of ethics

none of the above

 

s.

 

6. Imperative to the field of marriage and family therapy is the idea of:

a.psychoanalytic theory

b.the ‘traditional’ family

c.sex therapy

d.none of the above

7.Ethically marriage and family therapists are wise to initially consider their role as an advocate

for the:

a.relationship

b.child

c.individual

d.all of the above

8.The idea of was affirmed by the Declaration of Helsinki, after Nazi doctors at

concentration camps were found to have done harmful experiments on ethnic groups.

a.moral responsibility

b.confidential ity

c.informed consent

d.Hippocratic Oath

e.all of the above

9.The ethical codes of which two organizations apply SPECIFICALLY to marriage and family

counseling?

a.IAMFC and ASCA

b.APA and ACA

c.APA and ASCA

d.IAMFC and AAMFC

e.IAMFC and AAMFT

10. Values are:

a.imposed by ethical codes on such issues as divorce, sexuality, and family resource

management

b.unquestionable professional ethical standards

c.the legal rights of clients

d.none of the above

187

 

t.

 

11.Which is NOT one of the interventions which schools counselors use to provide direct services

in their schools?

a.coordination

b.consu Itation

c.counseling

d.cooperation

e.none of the above

12. Arnold v. Board of Education of Escambia County (1989) was a court decision regarding what?

a.a counselor giving a student advice on abortion

b.a counselor having inappropriate sexual relations with a student

c.a counselor withholding information about a threat which was made from a client towards

another person which resulted in that person’s death

d.a counselor failing to notify authorities of a student’s intent of suicide

e.none of the above

13.In determining what action a counselor should take in ethical dilemmas presented by poten-

tially detrimental relationships, which step to come to a conclusion is NOT listed in your text?

a.think carefully

b.consult the necessary codes and experts

c.identify the ethical issues

d.temporarily suspend the relationship until a conclusion is made

e.none of the above

14.The intent of the was to provide parents and eligible students (those

older than 18 years of age) the right to inspect their school records and the protection of dis-

semination of school records.

a.Drug Abuse Office and Treatment Act

b.Family Educational Rights and Privacy Act

c.Education for all Handicapped Children Act

d.Individual Education Disability Act

15.Approximately how many states grant students the legal right of privileged communication

when communicating with a school counselor?

a.10

b.20

c.30

d.40

188

 

u.

 

16.When considering a school counselor’s duty to warn and protect, which of the following state-

ments is true?

a.Counselors may be sued if they breach confidentiality, if a student injures themselves or

someone else or commits suicide.

b.Counselors cannot breach confidentiality ever.

c.Counselors may be sued by the school if they breach confidentiality with parents.

d.Counselors will not be sued unless they breach confidentiality.

17.According to the American School Counselor Association, failure to provide the needed food,

care, clothing, housing, medical attention and supervision of a child would be defined as:

a.child abuse

b.corporal punishment

c.child neglect

d.child endangerment

18. Managed care is usually a contracted arrangement between atn):

a.client and a counselor

b.social service agency and a client

c.counselor and employer

d.none of the above

19. RUST stands for:

a.Rehabi I itation Users Standards of Treatment

b.Redefining Undiagnosed or Subtle Terms

c.Responsibilities of Using Standardized Treatments

d.Relinquishing Use of Standardized Tests

e.none of the above

20. The evolution of career counseling has been influenced by which of the following?

a.social and cultural forces

b.legislation

c.programs created as a result of legislation

d.all of the above

189

 

v.

 

 

 

 

21.Counsel i ng that involves professional helpers who hel p cl ients “understand, accept, and

resolve their problems” by using “basic counseling techniques so that their clients can lead

more satisfying, well adjusted lives” would best define?

a.psychoanalysis

b.personal counseling

c.career counseling

d.vocational counseling

22. Which of the following is NOT one of the three required elements of informed consent?

a.capacity

b.comprehension

c.confidential ity

d.voluntariness

23.As a counselor if the ethical values at your place of employment are in conflict with your

professional ethics, what should you do?

a.stay on the job because there are some things you cannot change

b.talk with your co-workers about their thoughts

c.seriously consider resigning from your position

d.nothing, for there is nothing you can do about corporate culture

24.According to Pope (1999) when clients first present for career counseling it is important to

assess how much involvement of both is needed by the client in

their decision making process.

a.former employer and family

b.potential employer and former employer

c.significant other and children

d.extended family and community

25.Counselors should be aware of potentially detrimental counselor-client relationships and can

safeguard themselves by taking which of the following actions?

a.ongoing discussions to identify and work through conflicts or concerns that develop and

documentation of all events

b.consultation with a colleague to guard against overlooking a problem

c.supervision if a situation involves a high risk for harm

d.all of the above are safeguards that counselors should consider

 

 

Multiple Choice Questions (Enter your answers on the enclosed answer sheet)

1. Groups or group process may:

a.differ depending on the national origin of group members

b.be enhanced by the acceptance of differences among group members

c.be enhanced by a culturally sensitive counselor

d.all of the above

2. Related to privileged communication and group counseling, privileged communication:

a.can be guaranteed in all cases with a licensed professional

b.historically has been respected in group counseling

c.prevents gossip about cases to uninvolved third parties in informal settings

d.none of the above

3. Group counseling:

a.is practiced only in private practices

b.is a specialty of counseling meeting all standard criteria for defining a specialty

c.always is led by at least two counselors

d.band conly

e.none of the above

4. If a group of minors is being counseled, the parents of the minors:

a.must respect the counselor/client privilege of confidentiality

b.have the right to information about the nature and content of counseling

c.have the right to attend a group session as a chaperone

d.both band c

e.none of the above

5. The CRC code of ethics clearly asserts that the primary responsibility of counselors is to whom?

a.their employer

b.their supervisor

c.individuals with disabilities receiving services

d.third party payor

 

6.If the counselor holds the culturally dominant high level of value regarding traditional work,

he or she may not react positively to individuals who wish to work in which area?

a.factory settings

b.in-home as caregivers

c.only part time to pursue avocational interests

d.both band c are correct

7. Which of the following are areas in which rehabilitation counselors monitor their competence?

a.job development, placement and follow-up

b.integration of mental health counseling or diagnostic focus with their usual practices

c.competence in the area of assessment

d.both band c are correct

8. CRCC provides code of ethics enforcement for which of the following?

a.individuals who hold the CRC certification.

b.individual members of ACA and ARCA.

c.individual members of NRA and NRCA.

d.individuals who hold a CCM certification.

9. Major change within the 200112002 CRCC code of ethics had to do with what subject(s)?

a.major emphasis on multicultural considerations

b.new continuing education requirements

c.addition of an entire section on electronic communication

d.established dollar limits for billing of services

e.both a and c

10.The collaborative consorti um of key rehabiIitation counseling professional organ izations formed in 2004 is the:

a.Alliance for Rehabilitation Counseling

b.Rehabilitation Counseling Cooperative

c.National Rehabi I itation Association

d.American Rehabilitation Counselors United

e.none of the above

 

11. The two major professional organizations for rehabilitation counselors are:

 

a. ARCA and NRCA

b. ACA and ARCA

c. APA and NRCA

d. ARCAA and N RC

e. none of the above

12.According to your text, nearly of the U.S. population needed treatment for an alcohol

or illicit drug problem in 2003.

a.8

b.10

c.12

d.15

e.none of the above

13.This organization is the largest organization serving addiction counselors, educators, and other health care professionals who deal with addiction.

 

a. NAADC

b. ACA

c. APA

d. NAADAC

e. none of the above

14. Confidentiality in treatment of chemical dependency is unique due to:

a.state statute confidential ity

b.national professional certification

c.state professional certification

d.none of the above

15. The 12-step approach of Alcohol ics Anonymous has been:

a.discredited by the majority of professionals because of the religious nature of the program

b.shown to ONLY be effective when combined with professional interventions

c.proven to be effective not only with treating alcoholism, but with other addictions as well

d.none of the above

 

16.What is the NBCC specialty designation for counseling professionals who work primarily with addiction?

a.MACC

b.NBCCA

c.NAADAC

d.none of the above

17.Which is NOT a setti ng listed in your text in wh ich substance abuse treatment may be delivered?

a.outpatient setting

b.residential

c.hospital

d.all of the above are settings listed

18.How many of the criteria for substance dependence must be present for the diagnosis of alcohol or drug dependence?

a.two

b.three

c.four

d.five

e.none of the above

19. The ACS identifies content areas that training in clinical supervision must include.

a.5

b.9

c.13

d.26

20. Related to potential ethical situations, supervisors often have which of the following concerns?

a.most code of professional ethics have limited information regarding supervision

b.the supervisor must constantly examine the ethical issues that impact both the client and the supervisee

c.regulations for clinical supervisors provided are ambiguous from a legal perspective

d.both a and b are correct

 

21.A student counselor is providing services to a client and audiotapes each of the sessions for individual review with their supervisor and group review with their fellow students. The client was not informed that their counselor was a student in training or of the purpose of the audiotaping. The supervisor and supervisee have violated which of the following?

a.client informed consent

b.client confidentiality

c.supervisee confidentiality

d.both a and b are correct

22.A student is completing an internship at a work re-entry center. The student is female and worked with a male client whom she knew was attracted to her. During his rehabilitation he frequently brought her flowers, candy and cards of thanks. The student did not accept the gifts, rather placed them in a central location for all to benefit from. The student discussed this situation with her supervisor and followed agency policy and her supervisor’s directives during the entire time she was providing services to the client. Upon discharge the client asked the student for her phone number for the purposes of a social/romantic relationship. The stu-

dent gave the client her phone number and began dating the client two weeks after he was discharged. Another agency personnel saw the two in the community in a close embrace and reported this to the student’s supervisor. Upon hearing this information, the supervisor went to the student’s office, packed her belongi ngs and left them at the front desk with a note that her internship was terminated. The action of the supervisor violated the supervisee’s:

a.due process

b.confidentiality

c.informed consent

d.professional identity

e.none of the above

23.Which of the following are effective suggestions for supervisors to consider to avoid malpractice lawsu its?

a.possess appropriate knowledge, skill and work habits

b.foster healthy, respectful relationships

c.have keen knowledge of self

d.alloftheabove

24.After a hearing, a license board makes a decision which could include consequences. Which of the following is NOT a consequence as listed in your text?

a.revocation of a license

b.paying a fine

c.probation

d.reprimand

e.none of the above

 

25.Which of the following sources of ethical information has been given the highest rating by certified counselors?

a.ACA ethical code

b.APA Ethics Committee

c.ACA Journal of Counseling and Development

d.all of the above

e.a and conly

 
Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!