Showing papers on "Neglect published in 2002"

Brain damage: neglect disrupts the mental number line.

Abstract: A popular metaphor for the representation of numbers in the brain is the 'mental number line', in which numbers are represented in a continuous, quantity-based analogical format. Here we show that patients with hemispatial neglect misplace the midpoint of a numerical interval when asked to bisect it (for example, stating that five is halfway between two and six), with an error pattern that closely resembles the bisection of physical lines. This new form of representational neglect constitutes strong evidence that the mental number line is more than simply a metaphor, and that its spatial nature renders it functionally isomorphic to physical lines.

Childhood Experience and the Expression of Genetic Potential: What Childhood Neglect Tells Us About Nature and Nurture

Abstract: Studies of childhood abuse and neglect have important lessons for considerations of nature and nurture. While each child has unique genetic potentials, both human and animal studies point to important needs that every child has, and severe long-term consequences for brain function if those needs are not met. The effects of the childhood environment, favorable or unfavorable, interact with all the processes of neurodevelopment (neurogenesis, migration, differentiation, apop- tosis, arborization, synaptogenesis, synaptic sculpting, and myelination). The time courses of all these neural processes are reviewed here along with statements of core principles for both genetic and environmental influences on all of these processes. Evidence is presented that development of synaptic pathways tends to be a "use it or lose it" proposition. Abuse studies from the author's laboratory, studies of children in orphanages who lacked emotional contact, and a large number of animal deprivation and enrichment studies point to the need for children and young nonhuman mammals to have both stable emotional attachments with and touch from primary adult caregivers, and spontaneous interactions with peers. If these connections are lacking, brain development both of caring behavior and cognitive capacities is damaged in a lasting fashion. These effects of experience on the brain imply that effects of modern technology can be positive but need to be monitored. While technology has raised opportunities for children to become economically secure and literate, more recent inadvertent impacts of technology have spawned declines in extended families, family meals, and spontaneous peer interactions. The latter changes have deprived many children of experiences that promote positive growth of the cognitive and caring potentials of their developing brains.

Sensitivity of clinical and behavioural tests of spatial neglect after right hemisphere stroke

Abstract: Objectives: The lack of agreement regarding assessment methods is responsible for the variability in the reported rate of occurrence of spatial neglect after stroke. The aim of this study was to assess the sensitivity of different tests of neglect after right hemisphere stroke. Methods: Two hundred and six subacute right hemisphere stroke patients were given a test battery including a preliminary assessment of anosognosia and of visual extinction, a clinical assessment of gaze orientation and of personal neglect, and paper and pencil tests of spatial neglect in the peripersonal space. Patients were compared with a previously reported control group. A subgroup of patients (n=69) received a behavioural assessment of neglect in daily life situations. Results: The most sensitive paper and pencil measure was the starting point in the cancellation task. The whole battery was more sensitive than any single test alone. About 85% of patients Presented some degree of neglect on at least one measure. An important finding was that behavioural assessment of neglect in daily life was more sensitive than any other single measure of neglect. Behavioural neglect was considered as moderate to severe in 36% of cases. A factorial analysis revealed that paper and pencil tests were related to two underlying factors. Dissociations were found between extrapersonal neglect, personal neglect, anosognosia, and extinction. Anatomical analyses showed that neglect was more common and severe when the posterior association cortex was damaged. Conclusions: The automatic rightward orientation bias is the most sensitive clinical measure of neglect. Behavioural assessment is more sensitive than any single paper and pencil test. The results also support the assumption that neglect is a heterogeneous disorder.

The subcortical anatomy of human spatial neglect: putamen, caudate nucleus and pulvinar.

Abstract: Various studies have documented that right hemispheric lesions restricted to the basal ganglia or to the thalamus may evoke spatial neglect. However, for methodological reasons, the exact anatomical correlate of spatial neglect within these two subcortical structures still remained uncertain. The present study identified these locations by comparing the anatomy of subcortical lesions to the basal ganglia or thalamus between neglect and control patients. Analysis revealed that the putamen, the pulvinar and, to a smaller degree, the caudate nucleus are the subcortical structures typically associated with spatial neglect in humans. All these structures have direct anatomical connections to the superior temporal gyrus (STG), which recently has been identified as the neural correlate of spatial neglect in the human cortex. Therefore, it is assumed that the right putamen, caudate nucleus, pulvinar and STG form a coherent corticosubcortical anatomical network in the genesis of spatial neglect in humans.

Long‐lasting amelioration of visuospatial neglect by prism adaptation

Abstract: It has been shown that unilateral left neglect can be significantly improved for a short time after a short period of adaptation to a prismatic shift of the visual field to the right. In neuropsychological studies, however, there is no evidence demonstrating long‐lasting effects following treatment by prism adaptation (PA). The first aim of the present study was to find out whether the short‐term amelioration found after prismatic adaptation could be converted into long‐term therapeutic improvement. Secondly, we investigated whether the improvement of neglect in standard tests could be generalized to ecological visuospatial tests. Thirdly, the effects of prism adaptation on different spatial domains (far, near and personal space) were evaluated. Fourthly, the influence of PA on high‐order visuospatial functions, such as spatial representation, and on a low‐order factor, i.e. sensory–motor bias, was investigated. Finally, we investigated the possible correlation between neglect amelioration, the adaptation effect and the visuomotor after‐effect, as assessed by a pointing task during and after PA. Seven patients with right hemisphere lesion and left visuospatial neglect were treated with prismatic lenses in twice‐daily sessions over a period of 2 weeks. In each training session, patients were required to perform a pointing task wearing base‐left wedge prisms inducing a shift of the visual field to the right by 10°. The presence of visual neglect and the duration of the amelioration achieved were assessed before the treatment and 2 days, 1 week and 5 weeks after treatment by using a standardized battery that included a series of behavioural and ecological visuospatial tests. Six control, untreated patients, matched to the experimental group for gravity and duration of illness, were submitted to the same tests at the same intervals as the experimental patients. The results showed an improvement in the experimental patients’ performance after PA, which was maintained during the 5‐week period after treatment. The amelioration of neglect was found in standard as well as in behavioural tests and in all spatial domains. In contrast, control patients did not show any improvement in neglect. The amelioration of neglect occurred only in patients who showed the adaptation effect and the after‐effect in the pointing task. Neglect amelioration did not occur in one patient who did not show the adaptation effect and had an unstable after‐effect. In conclusion, these findings show that prism adaptation is a productive way of achieving long‐lasting improvements in neglect treatment.

Exposure to abuse, neglect, and household dysfunction among adults who witnessed intimate partner violence as children: implications for health and social services.

Abstract: Intimate partner violence (IPV) damages a woman's physical and mental well-being, and indicates that her children are likely to experience abuse, neglect and other traumatic experiences. Adult HMO members completed a questionnaire about adverse childhood experiences (ACEs) including childhood abuse, neglect, and household dysfunction. We used their responses to retrospectively assess the relationship between witnessing intimate partner violence and experiencing any of the 9 ACEs and multiple ACEs (ACE score). Compared to persons who grew up with no domestic violence, the adjusted odds ratio for any individual ACE was approximately two to six times higher if IPV occurred (p < 0.05). There was a powerful graded increase in the prevalence of every category of ACE as the frequency of witnessing IPV increased. In addition, the total number of ACEs was increased dramatically for persons who had witnessed IPV during childhood. There was a positive graded risk for self-reported alcoholism, illicit drug use, i.v. drug use and depressed affect as the frequency of witnessing IPV increased. Identification of victims of IPV must include screening of their children for abuse, neglect and other types of adverse exposures, as well as recognition that substance abuse and depressed affect are likely consequences of witnessing IPV. Finally, this data strongly suggest that future studies, which focus on the effect of witnessing IPV on long-term health outcomes, may need to take into consideration the co-occurrence of multiple ACEs, which can also affect these outcomes.

The Cognitive and Neural Bases of Spatial Neglect

Abstract: PART 1: HISTORICAL INTRODUCTION PART 2: NEURAL BASES OF NEGLECT PART 3: FRAMEWORKS OF NEGLECT PART 4: PERCEPTUAL AND MOTOR FACTORS PART 5: RELATION OF NEGLECT TO ATTENTION PART 6: COGNITIVE PROCESSES IN NEGLECT PART 7: REHABILITATION OF PATIENTS WITH NEGLECT

Subcortical aphasia and neglect in acute stroke: the role of cortical hypoperfusion

Abstract: Summary We have hypothesized that most cases of aphasia or hemispatial neglect due to acute, subcortical infarct can be accounted for by concurrent cortical hypoperfusion. To test this hypothesis, we demonstrate: (i) that pure subcortical infarctions are associated with cortical hypoperfusion in subjects with aphasia/neglect; (ii) that reversal of cortical hypoperfusion is associated with resolution of the aphasia; and (iii) that aphasia/neglect strongly predicts cortical ischaemia and/or hypoperfusion. We prospectively evaluated a consecutive series of 115 patients who presented within 24 h of onset or progression of stroke symptoms, with MRI sequences including diffusion weighted imaging (DWI) and perfusion weighted imaging (PWI), and detailed testing for aphasia or hemispatial neglect. The association between aphasia or neglect and cortical infarct (or dense ischaemia) on DWI and cortical hypoperfusion indicated by PWI, was evaluated with chi-squared analyses. Fisher exact tests were used for analyses with small samples. Cases of DWI lesion restricted to subcortical white matter and/or grey matter structures (n = 44) were examined for the presence of aphasia or neglect, and for the presence of cortical hypoperfusion. In addition, subjects who received intervention to restore perfusion were evaluated with DWI, PWI, and cognitive tests before and after intervention. Finally, the positive predictive value of the cognitive deficits for identifying cortical abnormalities on DWI and PWI were calculated from all patients. Of the subjects with only subcortical lesions on DWI in this study (n = 44), all those who had aphasia or neglect showed concurrent cortical hypoperfusion. Among the patients who received intervention that successfully restored cortical perfusion, 100% (six out of six) showed immediate resolution of aphasia. In the 115 patients, aphasia and neglect were much more strongly associated with cortical hypoperfusion (c 2 = 57.3 for aphasia; c 2 = 28.7 for neglect; d.f. = 1; P < 0.000001 for each), than with cortical infarct/ischaemia on DWI (c 2 = 8.5 for aphasia; c 2 = 9.7 for neglect; d.f. = 1; P < 0.005 for each). Aphasia showed a much higher positive predictive value for cortical abnormality on PWI (95%) than on DWI (62%), as did neglect (100% positive predictive value for PWI versus 74% for DWI). From these data we conclude that aphasia and neglect due to acute subcortical stroke can be largely explained by cortical hypoperfusion.

Child abuse and neglect by parents and other caregivers.

Abstract: Child abuse has for a long time been recorded in literature art and science in many parts of the world. Reports of infanticide mutilation abandonment and other forms of violence against children date back to ancient civilizations. The historical record is also filled with reports of unkempt weak and malnourished children cast out by families to fend for themselves and of children who have been sexually abused. For a long time also there have existed charitable groups and others concerned with children’s wellbeing who have advocated the protection of children. Nevertheless the issue did not receive widespread attention by the medical profession or the general public until 1962 with the publication of a seminal work The battered child syndrome by Kempe et al. The term "battered child syndrome" was coined to characterize the clinical manifestations of serious physical abuse in young children. Now four decades later there is clear evidence that child abuse is a global problem. It occurs in a variety of forms and is deeply rooted in cultural economic and social practices. Solving this global problem however requires a much better understanding of its occurrence in a range of settings as well as of its causes and consequences in these settings. (excerpt)

Work, Welfare, and Child Maltreatment

Abstract: We examine how child maltreatment—including neglect, physical and sexual abuse, and other forms of maltreatment—is affected by parental economic circumstances. Using state‐level panel data on cases of maltreatment and numbers of children in foster care, we find that increases in the fractions of children with absent fathers and working mothers in a state are related to increases in many measures of maltreatment, as are increases in the share of families with two nonworking parents and those with incomes below 75% of the poverty line. Decreases in state welfare benefit levels are associated with increases in foster care placement.

Neck muscle vibration induces lasting recovery in spatial neglect

Abstract: Objectives: To evaluate whether neck muscle vibration is an effective technique for neglect rehabilitation, with lasting beneficial effects. Methods: The effects of differential treatment of visual exploration training alone or in combination with neck muscle vibration were evaluated in a crossover study of two matched groups of 10 patients suffering from left sided neglect. Each group received a sequence of 15 consecutive sessions of exploration training and combined treatment. The effects of treatment were assessed with respect to different aspects of the neglect disorder such as impaired perception of the egocentric midline, exploration deficits in visual and tactile modes, and visual size distortion. The transfer of treatment effects to activities of daily living was examined by a reading test and a questionnaire of neglect related everyday problems. All variables were measured six times: three baseline measurements, two post-treatment measurements, and one follow up after two months. Results: The results showed superior effects of combination treatment. A specific and lasting reduction in the symptoms of neglect was achieved in the visual mode, which transferred to the tactile mode with a concomitant improvement in activities of daily living. The improvement was evident two months after the completion of treatment. In contrast, isolated exploration training resulted in only minor therapeutic benefits in visual exploration without any significant transfer effects to other tasks. Conclusions: Neck muscle vibration is a decisive factor in the rehabilitation of spatial neglect and induces lasting recovery when given as a supplement to conventional exploration training.

Probability Cuing of Target Location Facilitates Visual Search Implicitly in Normal Participants and Patients with Hemispatial Neglect

Abstract: We explored how variability in the probability of target lo- cations affects visual search in normal individuals and in patients with hemispatial neglect, a deficit in attending to the contralesional side of space. Young and elderly normal participants responded faster when targets appeared in the more probable region than when targets ap- peared in the less probable region. Similarly, patients were sensitive to the distribution of targets, even in the neglected field. Although the at- tentional gradient that characterizes neglect was not eliminated, the response facilitation due to the probability distribution was propor- tionate to that of control participants and equal in magnitude across the neglected field. All participants exploited the uneven distribution of targets to enhance task performance without explicit instructions to do so or awareness of biases in their behavior. These results suggest that attentional orientation and sensitivity to external probabilities are possibly dissociable. An early sensory and a late motor mechanism are postulated as possibly being involved in the observed probability- matching behavior of participants.

Probability Neglect: Emotions, Worst Cases, and Law

Abstract: When strong emotions are triggered by a risk, people show a remarkable tendency to neglect a small probability that the risk will actually come to fruition. Experimental evidence, involving electric shocks and arsenic, supports this claim, as does real-world evidence, involving responses to abandoned hazardous waste dumps, the pesticide Alar, and anthrax. The resulting “probability neglect” has many implications for law and policy. It suggests the need for institutional constraints on policies based on ungrounded fears; it also shows how government might effectively draw attention to risks that warrant special concern. Probability neglect helps to explain the enactment of certain legislation, in which government, no less than ordinary people, suffers from that form of neglect. When people are neglecting the fact that the probability of harm is small, government should generally attempt to inform people, rather than cater to their excessive fear. But when information will not help, government should respond, at least if analysis suggest that the benefits outweigh the costs. The reason is that fear, even if it is excessive, is itself a significant problem, and can create additional significant problems. “If someone is predisposed to be worried, degrees of unlikeliness seem to provide no comfort, unless one can prove that harm is absolutely impossible, which itself is not possible.”1 “[A]ffect-rich outcomes yield pronounced overweighting of small probabilities . . . .”2 “On Sept. 11, Americans entered a new and frightening geography, where the continents of safety and danger seemed forever shifted. Is it safe to fly? Will terrorists wage germ warfare? Where is the line between reasonable precaution and panic? Jittery, uncertain and assuming the worst, many people have answered these questions by forswearing air travel, purchasing gas masks and radiation detectors, placing frantic calls to pediatricians demanding vaccinations against exotic diseases or rushing out to fill prescriptions for Cipro, an antibiotic most experts consider an unnecessary defense against anthrax.”3 *Karl N. Llewellyn Distinguished Service Professor, University of Chicago, Law School and Department of Political Science. I am grateful to Christine Jolls, Eric Posner, Richard Posner, and Adrian Vermeule for helpful comments on a previous draft, and to Martha Nussbaum for valuable discussion. 1See John Weingart, Waste Is A Terrible Thing To Mind 362 (2001). 2Yuval Rottenstreich and Christopher Hsee, Money, Kisses, and Electric Shocks: On the Affective Psychology of Risk, 12 Psych Rev. 185, 188 (2001). 3Erica Goode, Rational and Irrational Fears Combine in Terrorism's Wake, The New York Times, Oct. 2, 2001.

Exploring psychological abuse in childhood: II. Association with other abuse and adult clinical depression

Abstract: A new retrospective interview assessment of childhood psychological abuse, an extension to the Childhood Experience of Care and Abuse (CECA) instrument, is described in a companion article (Moran, Bifulco, Ball, Jacobs, & Benaim, 2002). The purpose of the present article is to examine the relationship of childhood psychological abuse to other adverse childhood experiences and to major depression and suicidal behavior in adult life. Childhood experience and lifetime disorder were assessed retrospectively in a high-risk, community series of London women (n = 204). Psychological abuse from parents was examined in relation to seven other parental behaviors (neglect, antipathy, role reversal, discipline, supervision, physical abuse, and sexual abuse). Psychological abuse was significantly related to all seven behaviors. The highest associations found were to antipathy (gamma = .76), neglect (.73), and sexual abuse (.72). Factor analysis showed the existence of two factors reflecting care and control, with psychological abuse associated with both factors. Childhood psychological abuse was highly related to chronic or recurrent adult depression, with a "dose-response" evident for severity of abuse. The rates ranged from 83% for "marked" to 55% for "mild" abuse and 37% for "little/no" psychological abuse (p < .002). Psychological abuse was also related to lifetime suicidal behavior but here any level of abuse from marked to mild had similar rates (36% overall vs. 18% with no psychological abuse, p < .04). There was no evidence of specificity of childhood experience to adult depression; nearly all types of childhood adversity examined were significantly related. An analysis using an index of multiple abuse, including psychological abuse, showed a clear dose-response relationship to disorder. Somewhat fewer forms of maltreatment were related to suicidal behavior, but again multiples showed a clear dose-response effect.

Childhood adversity, parental vulnerability and disorder: examining inter‐generational transmission of risk

Abstract: Background: An investigation of intergenerational factors associated with psychiatric disorder in late adolescence/early adulthood was undertaken to differentiate influences from maternal disorder, maternal poor psychosocial functioning and poor parenting, on offspring. Method: The sample comprised an intensively studied series of 276 mother–offspring pairs in a relatively deprived inner-city London area with high rates of lone parenthood and socio-economic disadvantage. The paired sample was collected over two time periods: first a consecutively screened series of mothers and offspring in 1985–90 (n ¼ 172 pairs) and second a ‘vulnerable’ series of mothers and offspring in 1995–99 (n ¼ 104 pairs). The vulnerable mothers were selected for poor interpersonal functioning and/or low self-esteem and the consecutive series were used for comparison. Rates of childhood adversity and disorder in the offspring were examined in the two groups. Maternal characteristics including psychosocial vulnerability and depression were then examined in relation to risk transmission. Results: Offspring of vulnerable mothers had a fourfold higher rate of yearly disorder than those in the comparison series (43% vs. 11%,p < :001). They were twice as likely as those in the comparison series to have experienced childhood adversity comprising either severe neglect, physical or sexual abuse before age 17. Physical abuse, in particular, perpetrated either by mother or father/surrogate father was significantly raised in the vulnerable group. Analysis of the combined series showed that maternal vulnerability and neglect/abuse of offspring provided the best model for offspring disorder. Maternal history of depression had no direct effect on offspring disorder; its effects were entirely mediated by offspring neglect/abuse. Maternal childhood adversity also had no direct effect. Conclusions: Results are discussed in relation to psychosocial models of risk transmission for disorder. Maternal poor psychosocial functioning needs to be identified as a factor requiring intervention in order to stem escalation of risk across generations.

Neglect and anosognosia after first-ever stroke: incidence and relationship to disability.

Abstract: Neglect and anosognosia are serious consequences of stroke. Authors have found great variations in their incidence and their relationship to disability has been unclear. We studied the incidence of neglect and anosognosia within the scope of a population-based stroke-incidence study, and also evaluated their impact on disability. Four tests of visuo-spatial neglect, four tests of personal neglect, and an anosognosia questionnaire were used. Sixty-two patients (23%) of the study group had visuo-spatial neglect according to our definition, 21 patients (8%) had personal neglect, and 48 (17%) showed signs of anosognosia. Using a multiple logistic regression model, we found that both neglect and anosognosia influenced disability. To ascertain the true incidence of neglect and anosognosia after stroke, it is necessary to use a community-based study design, where cases treated outside the hospital are included. Some of the variability found in previous incidence studies is likely to be explained by not using such a design.

Adult attachment style. II: Its relationship to psychosocial depressive-vulnerability

Abstract: Background A range of studies show adult attachment style is associated with depressive-vulnerability factors such as low self-esteem, poor support and childhood adversity. However, there is wide inconsistency shown in the type of insecure style most highly associated. Few studies have examined attachment style in relation to clinical depression together with a range of such factors in epidemiological series. The present study uses an interview measure of adult attachment which differentiates type of attachment style and degree of insecurity of attachment, to see: (a) if it adds to other vulnerability in predicting depression and (b) if there is specificity of style to type of vulnerability. Method Two hundred and twenty-two high-risk and 80 comparison women were selected from questionnaire screenings of London GP patient lists and intensively interviewed. The Attachment Style Interview (ASI) differentiated five styles (Enmeshed, Fearful, Angry-dismissive, Withdrawn and Standard) as well as the degree to which attitudes and behaviour within such styles were dysfunctional (‘non-standard’). Attachment style was examined in relation to low self-esteem, support and childhood experience of neglect or abuse, and all of these examined in relation to clinical depression in a 12-month period. Results The presence of any ‘non-standard’ style was significantly related to poor support, low self-esteem and childhood adversity. Some specificity of type of style and type of vulnerability was observed. Logistic regression showed that non-standard Enmeshed, Fearful and Angry-dismissive styles, poor support and childhood neglect/abuse provided the best model for clinical depression. Conclusion Non-standard attachment in the form of markedly Enmeshed, Fearful or Angry-dismissive styles was shown to be associated with other depressive-vulnerability factors involving close relationships, self-esteem and childhood adversity and added to these in modelling depression.

Missing Voices Views of Older Persons on Elder Abuse

Abstract: Elder abuse, the mistreatment of older people, though a manifestation of the timeless phenomenon of inter-personal violence, is now achieving due recognition Prevalence studies concerning abuse of older persons have so far been restricted to developed nations. In developing countries, though, there is no systematic collection of statistics or prevalence studies, crime records, journalistic reports, social welfare records and small scale studies to provide evidence that abuse, neglect and financial exploitation of elders are widely prevalent. The World Health Organization(WHO) has recognised the need to develop a global strategy for the prevention of the abuse of older people. This strategy is being developed within the framework of a working partnership between the WHO Ageing and Life Course unit of the Department of Noncommunicable Disease Prevention and Health Promotion, the WHO Department of Injuries and Violence Prevention, the International Network for the Prevention of Elder Abuse(INPEA), HelpAge International and partners from academic institutions in a range of countries. The initial step towards developing the global strategy was the set up of a study in eight countries: Argentina, Austria, Brazil, Canada, India, Kenya, Lebanon and Sweden. The study`s main approach involved the conduct of focus groups with older persons in the community, and with primary health care workers, in order to establish components of elder abuse as identified by older people themselves and by those forming the primary health care teams. A focus on primary health care context was chosen as it is within this context that elder abuse can first be identified - or overlooked altogether. Making primary health care workers aware of the problem is thus a crucial step in preventing and/or managing elder abuse. This report presents the design and findings of the study, and the conclusions of a meeting(Geneva 11-13 October 2001) aimed at identifying the indications for policy, research and action emerging from these study findings. Reports from each country prepared by the national teams were reviewed and analysed at the meeting. Analysis of the major themes revealed remarkable similarities across the participating countries. Older people perceived abuse under three broad areas: ·Neglect - isolation, abandonment and social exclusion ·Violation - of human, legal and medical rights ·Deprivation - of choices, decisions, status, finances and respect The conclusions contain recommendations for action, some of which are already being implemented, with others to follow in the near future. These recommendations can be summarised as follows: ·To develop a screening and assessment tool for use in primary health care settings ·To develop an education package on elder abuse for primary health care professionals ·To develop and disseminate a research methodology `kit` to study elder abuse ·To develop a Minimum Data Set concerning violence and older people ·To ensure dissemination of the research findings through scientific journals ·To develop a global inventory of good practice ·To mobilize civil society through raising awareness of the widespread magnitude of elder abuse

Changing the focus: the case for recognizing and treating cannabis use disorders.

Abstract: During the late 1960s, cannabis emerged from relative obscurity to become the most common illicit drug used in the United States, and has remained so ever since. From an epidemiological perspective, three major waves of successively younger new users can be identified during the past 40 years. Contrary to popular opinion, cannabis use can be problematic for many people (particularly adolescents). Moreover, the drug has become increasingly more potent. Cannabis is currently one of the leading substances reported in arrests, emergency room admissions, autopsies and treatment admissions. Like alcohol and tobacco, the need for effective approaches to treating cannabis use disorders transcends debates about whether it should be legal. Moreover, the costs to society are continuing to mount from past neglect of this continuing public health problem. This paper provides background on the need to develop effective models for treating cannabis use disorders.

The Well-Being of Children Involved with the Child Welfare System: A National Overview

Abstract: Most children involved with the child welfare system have experienced abuse or neglect and separation from a parent. These traumatic experiences can lead to a variety of behavioral and emotional problems including severe attachment disorders. Additionally, many children in the child welfare system not only come from but are placed in high-risk home environments characterized by poverty, instability, and parents or caregivers with poor psychological well-being. These factors can also contribute to a greater likelihood of poor child well-being, further compromising the healthy development of an already vulnerable group of children.

Effects of News Coverage on Policy Attention and Actions A Closer Look Into the Media-Policy Connection

Abstract: Studies that examine the media-policy connection often neglect to fully explore the dynamic nature of this association over time. It is suggested that a conceptual framework that separates media effects on policy makers’ attention to issues from effects on their actual behavior (or policy actions) may be key for studying the dynamic relationshipbetween information in the media and policy response to this information. Employing this approach to the case of drunk driving between 1978 and 1995, it was found that heightened media attention to the drunk-driving problem at the beginning of the issue-attention cycle (the early 1980s) attracted greater policy attention to this issue and pressured policy makers to generate immediate, short-term solutions to the problem. Yet, once the volume of media attention to this issue started to wane (from the late 1980s onward), policy preferences gradually shifted to long-term solutions. Early discussions of the relationship between the mass media and public policy making centered on the idea that the mass media occupy a role of liaison between citizens and governments (Siebert, Peterson, & Schramm, 1956). First, the media cover issues that are prioritized by governments and elites. Next, media representations of these issues stimulate public discussions that help to crystallize individual opinions on these matters. Finally, the media collect individual opinions to represent public opinion that policy makers rely on for feedback on their own performance while learning about issues that matter to the public. Later on, as research on the media-policy link became primarily the domain of agenda-setting research (Dearing & Rogers, 1996), researchers have come to realize that a direct, symbiotic link exists between the media and policy agendas. That is, policy makers tend to infer the public’s stand on issues from the media agenda (Linsky, 1986) and, at the same time,