Department of Veterans Affairs' contributions to treatment outcomes research in aphasia

Background: Since at least 1948, Veterans Administration (VA) clinicians have been reporting the outcomes of treatment administered to mend aphasia. These range from retrospective clinical observations to controlled, multicentre clinical trials. While the rigour of research varies among reports, the body of work is considerable.

Aims: The purpose of this paper is to review VA contributions to treatment outcomes research in aphasia.

Methods & Procedures: Examples of VA aphasia treatment outcomes research were selected from a corpus of over 100 reports. Each was classified in the traditional, five‐phase, treatment outcomes research model, and each was rated by a levels of evidence scale.

Outcomes & Results: VA aphasia treatment outcomes research, like the bulk of aphasia treatment outcomes research, is patchy. There is little evidence of systematic progression through the traditional, five‐phase, treatment outcomes research model. It is also difficult to classify and to assign a level of evidence to many investigations. There is no VA aphasia treatment outcomes research on the effectiveness of the few treatments that have been demonstrated to be efficacious. Nevertheless, the amount of VA aphasia treatment outcomes research is massive, and its contribution to what can be said about the influence of treatment on aphasia is considerable.

Conclusions: For almost 60 years the VA has been contributing to treatment outcomes research in aphasia. No other single healthcare system can match the volume of this research. Lack of a systematic research programme may limit precise conclusions, but it does not diminish the significant contributions.     

A randomized controlled trial of goal choice interventions for alcohol use disorders among men who have sex with men

This study tested the efficacy of behavioral treatments for alcohol use disorders (AUD) among men who have sex with men (MSM) and who are at risk for HIV transmission. HIV-negative MSM with current AUD (N = 198) were recruited, offered treatment focused on reducing drinking and HIV risk, and followed during treatment and 12 months posttreatment. Participants (n = 89) accepted treatment and were randomized to either 4 sessions of motivational interviewing (MI) or 12 sessions of combined MI and coping skills training (MI + CBT). Other participants (n = 109) declined treatment but were followed, forming a non-help-seeking group (NHS). MI yielded significantly better drinking outcomes during the 12-week treatment period than MI + CBT, but posttreatment outcomes were equivalent. NHS participants significantly reduced their drinking as well. Service delivery and treatment research implications are discussed.     

The increase in longitudinally measured sleepiness across adolescence is related to the maturational decline in low-frequency EEG power

OBJECTIVES: A changing sleep schedule that reduces sleep duration is thought to produce the increasing daytime sleepiness of adolescents. We tested the hypothesis that adolescent daytime sleepiness also results from adolescent brain maturational processes indexed by declining delta electroencephalographic (EEG) activity. DESIGN: Data are from the first 3 years of a semilongitudinal study of EEG changes in adolescence. All-night EEG was recorded semiannually. SETTING: EEG was recorded with ambulatory recorders in the subjects' homes. PARTICIPANTS: Thirty-one subjects were 9 years old (cohort C9), and 38 subjects were 12 years old (cohort C12) at the start of the study. MEASUREMENTS: EEG power density (power/minute) was calculated for the first 5 hours of non-rapid eye movement sleep. Subjects rated sleepiness on a modified Epworth Sleepiness Scale. Habitual sleep schedules were assessed with self-reports and actigraphy. RESULTS: In C9 subjects, sleepiness increased slightly and was related only to age. In C12 subjects, the increase in subjective sleepiness was related to changes in age, bedtime, time in bed, and a wide frequency range of EEG power density. Sleepiness was not related to rise time, non-rapid eye movement sleep duration, rapid eye movement sleep duration, or total sleep time. With sleep schedule measures statistically controlled, the increase in sleepiness in the C12 group was strongly related to declining delta power density and, unexpectedly, even more strongly related to declining theta power density. CONCLUSIONS: The data support our hypothesis that, independent of sleep schedule changes, increasing adolescent daytime sleepiness is related to brain maturational changes indexed by declining EEG power. Our working hypothesis is that the declines in delta and theta power are correlates of an adolescent synaptic pruning that reduces waking arousal levels.     

Initial Validation and Measurement Invariance of the Active Inhibition Scale Among Traumatized and Grieving Youth

The Active Inhibition Scale (AIS; Ayers, Sandler, & Twohey, 1998) is an 11-item, self-report measure of emotional suppression among children and adolescents. Previous research with the AIS has linked emotional suppression to several clinically significant outcomes, such as posttraumatic stress symptoms (PTSS) and suicide, among trauma-exposed and bereaved youth; however, there are no published evaluations of its psychometric properties. We examined the factor structure and criterion validity of the AIS in two samples. Sample 1 included youth (M = 12.22 years, SD = 2.96, range: 6–18 years; 55.4% female) referred to an outpatient psychology clinic specializing in childhood trauma and grief. Sample 2 included youth (M = 13.18 years, SD = 2.58, range: 8–18 years; 61.8% female) referred to a community grief counseling center. Confirmatory factor analytic results supported a one-factor solution, Cronbach's α = .94. Additionally, AIS scores correlated positively with PTSS, depression, and maladaptive grief, rs = .43–.64. Evidence of factorial invariance was found across gender, race/ethnicity, and age group. Emotional suppression scores were higher among girls compared to boys, Black and Hispanic youth compared to White youth, and older compared to younger age groups. The magnitude of correlations between AIS and symptom measure scores was comparable across groups. These results support the reliability and criterion validity of the AIS with diverse youth populations and underscore the role that emotional suppression may play in explaining group differences in mental health symptoms.     

Response of Three Hormones to Diazepam Challenge in Sons of Alcoholics and Controls

This study evaluates the hypothesis that the decreased reaction to ethanol reported for sons of alcoholics will also be observed following infusions of a benzodiazepine. The investigation compared 37 men who were family history positive for alcoholism with 37 family history negative controls on postinfusion levels of cortisol, prolactin, and growth hormone following 0.12 and 0.20 mg/kg of diazepam given IV over 7 minutes. The results demonstrated no evidence of a decreased response for the sons of alcoholics on the levels of these three hormones.