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Dr. Rachel Kahn Dds

109 Federal Road
Brookfield CT 06804
203 751-1771
Medical School: Other - Unknown
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License #: 9146
NPI: 1316004104
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Delay Discounting Mediates Parent-Adolescent Relationship Quality and Risky Sexual Behavior for Low Self-Control Adolescents. - Journal of youth and adolescence
Parent-adolescent relationship quality and delay discounting may play important roles in adolescents' sexual decision making processes, and levels of self-control during adolescence could act as a buffer within these factors. This longitudinal study included 219 adolescent (55 % male; mean age = 12.66 years at Wave 1; mean age = 15.10 years at Wave 2) and primary caregiver dyads. Structural equation modeling (SEM) was utilized to determine whether delay discounting mediated the association between parent-adolescent relationship quality and adolescents' risky sexual behavior and how this mediated association may differ between those with high versus low self-control. The results revealed parent-adolescent relationship quality plays a role in the development of risky sexual behavior indirectly through levels of delay discounting, but only for adolescents with low self-control. These findings could inform sex education policies and health prevention programs that address adolescent risky sexual behavior.
The Social, Behavioral, and Emotional Correlates of Bullying and Victimization in a School-Based Sample. - Journal of abnormal child psychology
Bullying is a prevalent problem in schools that is associated with a number of negative outcomes for both the child who bullies and his or her victims. In a community sample of 284 ethnically diverse school-children (54.2 % girls) between the ages of 9 and 14 years (M = 11.28, SD = 1.82), the current study examined whether the level of victimization moderated the association between bullying and several behavioral, social, and emotional characteristics. These characteristics were specifically chosen to integrate research on distinct developmental pathways to conduct problems with research on the characteristics shown by children who bully others. Results indicated that both bullying and victimization were independently associated with conduct problems. However, there was an interaction between bullying and victimization in the prediction of callous-unemotional (CU) traits, such that the association between bullying and CU traits was stronger for those lower on victimization. Further, bullying was positively associated with positive attitudes towards bullying and anger expression and neither of these associations were moderated by the level of victimization. In contrast, bullying was not associated with the child's perceived problems regulating anger, suggesting that children with higher levels of bullying admit to expressing anger but consider this emotional expression as being under their control.
The road forward for research on callous-unemotional traits: reply to Lahey (2014). - Psychological bulletin
Lahey (2014) provides a thoughtful and scholarly discussion of our review of the research on the potential utility of callous-unemotional (CU) traits for designating a distinct subgroup of children and adolescents with severe conduct problems. In this reply, we attempt to clarify several issues raised in Lahey's commentary. Specifically, by focusing largely on only 1 part of the research review (i.e., implications for evaluating the new specifier included for the diagnosis of conduct disorder in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders; American Psychiatric Association, 2013), the commentary underestimates the available empirical support for the utility of these traits for designating an important subgroup of children and adolescents with severe conduct problems. Furthermore, we highlight a number of studies that provide data inconsistent with the model proposed by Lahey in which CU traits are best considered as solely a marker of more severe conduct problems. Finally, we highlight limitations in estimating the stability of CU traits based solely on the number of individuals who continue to fall above and below a diagnostic cutoff at 2 points in time.(PsycINFO Database Record (c) 2013 APA, all rights reserved).
A Validation of the Inventory of Callous-Unemotional Traits in a Community Sample of Young Adult Males. - Journal of psychopathology and behavioral assessment
Callous-unemotional (CU) traits have been shown to delineate a subgroup of individuals at high risk for exhibiting severe and persistent criminal behavior. The Inventory of Callous-Unemotional Traits (ICU; Frick 2004) was recently developed as a comprehensive rating scale designed to measure multiple facets of CU traits. However, validation of this measure has been limited to youth in adolescence and emerging adulthood (age range=12-20), leaving questions about the utility of this measure in early adulthood unanswered. The current study evaluated the factor structure of the ICU within a racially diverse and well characterized community sample of adult males (n=425) using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). While results found the best fitting model to be the three-bifactor structure that has been previously reported in adolescent samples, the fit indices were only marginally acceptable and suggest the need for scale refinement. Total and subscales scores demonstrated significant and distinct associations with relevant external criteria (e.g., delinquency, psychopathy, psychopathology, psychosocial functioning). Implications and directions for future research are discussed.
Consolidation whole abdomen irradiation following adjuvant carboplatin-paclitaxel based chemotherapy for advanced uterine epithelial cancer: feasibility, toxicity and outcomes. - Radiation oncology (London, England)
To evaluate feasibility and preliminary outcomes associated with sequential whole abdomen irradiation (WAI) as consolidative treatment following comprehensive surgery and systemic chemotherapy for advanced endometrial cancer.We conducted a retrospective analysis of patients treated at our institution from 2000 to 2011. Inclusion criteria were stage III-IV endometrial cancer patients with histological proof of one or more sites of extra-uterine abdomen-confined disease, treated with WAI as part of multimodal therapy. Endpoints were feasibility, acute toxicity, late effects, recurrence-free survival (RFS) and overall survival (OS). Twenty patients were identified. Chemotherapy consisted of 3 to 6 cycles of a platinum-paclitaxel regimen in 18 patients. WAI was delivered using conventional technique to a median total dose of 27.5 Gy.No grade 4 toxicities occurred during chemotherapy or radiotherapy. No radiation dose reduction was necessary. Three patients developed small bowel obstruction, all in the context of recurrent intraperitoneal disease. Kaplan-Meier estimates and 95% confidence intervals for RFS and OS at one year were 63% (38-80%) and 83% (56-94%) and at 3 years 57% (33-76%) and 62% (34-81%), respectively. On univariate Cox analysis, stage IVB and serous papillary (SP) histology were found to be statistically significantly (at the p = 0.05 level) associated with worse RFS and OS. The peritoneal cavity was the most frequent site of initial failure.Consolidative WAI following chemotherapy is feasible and can be performed without interruption with manageable acute and late toxicity. Patients with endometrioid adenocarcinoma, especially stage FIGO III, had favorable outcomes possibly meriting prospective evaluation of the addition of WAI following chemotherapy in selected patients. Patients with SP do poorly and do not routinely benefit from this approach.
Annual research review: A developmental psychopathology approach to understanding callous-unemotional traits in children and adolescents with serious conduct problems. - Journal of child psychology and psychiatry, and allied disciplines
Recent research has suggested that the presence of significant levels of callous-unemotional (CU) traits designates a clinically important and etiologically distinct subgroup of children and adolescents with serious conduct problems. Based on this research, CU traits have been included in the most recent revision of the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5; American Psychiatric Association, 2013)--as a specifier for the diagnosis of conduct disorder. In this review, we attempt to understand CU traits within a developmental psychopathological framework. Specifically, we summarize research on the normal development of the prosocial emotions of empathy and guilt (i.e., conscience) and we illustrate how the development of CU traits can be viewed as the normal development of conscience gone awry. Furthermore, we review research on the stability of CU traits across different developmental periods and highlight factors that can influence this stability. Finally, we highlight the implications of this developmental psychopathological framework for future etiological research, for assessment and diagnostic classification, and for treatment of children with serious conduct problems.© 2013 The Authors. Journal of Child Psychology and Psychiatry © 2013 Association for Child and Adolescent Mental Health.
Callous-unemotional traits and anxiety in a community sample of 7-year-olds. - Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53
In forensic samples of adults and adolescents, there is evidence to suggest that there may be distinct variants of psychopathy marked by the presence/absence of significant levels of anxiety. Callous-unemotional (CU) traits can be used to characterize children who share behavioural and neurocognitive features with adult psychopaths. The aims of this paper are to (a) investigate the genetic and environmental influences on CU traits with/without anxiety and (b) explore differences in terms of concurrent and early parenting and adjustment. Discrete groups were formed on the basis of scores in the top 10% of the sample on CU and anxiety scales at age 7. Estimates of group heritability were calculated using a Defries-Fulker (DF) extremes regression model. Follow back analyses of early parenting and adjustment were conducted using multivariate analyses of covariance. There was high group heritability for CU traits with/without anxiety. Children with both high CU and anxiety showed greater levels of adjustment problems than those with CU only at age 7. The two groups did not differ in parenting characteristics. In this general population sample, evidence did not support differences in etiology for the two groups high on CU traits differing in level of anxiety.
Subcomponents of psychopathy have opposing correlations with punishment judgments. - Journal of personality and social psychology
Psychopathy research is plagued by an enigma: Psychopaths reliably act immorally, but they also accurately report whether an action is morally wrong. The current study revealed that cooperative suppressor effects and conflicting subsets of personality traits within the construct of psychopathy might help explain this conundrum. Among a sample of adult male offenders (N = 100) who ranked deserved punishment of crimes, Psychopathy Checklist-Revised (PCL-R) total scores were not linearly correlated with deserved punishment task performance. However, these null results masked significant opposing associations between task performance and factors of psychopathy: the PCL-R Interpersonal/Affective (i.e., manipulative and callous) factor was positively associated with task performance, while the PCL-R Social Deviance (i.e., impulsive and antisocial) factor was simultaneously negatively associated with task performance. These relationships were qualified by a significant interaction where the Interpersonal/Affective traits were positively associated with task performance when Social Deviance traits were high, but Social Deviance traits were negatively associated with task performance when Interpersonal/Affective traits were low. This interaction helped reveal a significant nonlinear relationship between PCL-R total scores and task performance such that individuals with very low or very high PCL-R total scores performed better than those with middle-range PCL-R total scores. These results may explain the enigma of why individuals with very high psychopathic traits, but not other groups of antisocial individuals, usually have normal moral judgment in laboratory settings, but still behave immorally, especially in contexts where social deviance traits have strong influence.
Can callous-unemotional traits enhance the understanding, diagnosis, and treatment of serious conduct problems in children and adolescents? A comprehensive review. - Psychological bulletin
This article provides a comprehensive review of the research on the use of callous and unemotional (CU) traits for designating an important subgroup of children and adolescents with severe conduct problems. It focuses on the etiological significance of recognizing this subgroup of youths with severe conduct problems, its implications for diagnostic classification, and the treatment implications of this research. The review highlights limitations in existing research and provides directions for future research. The available research suggests that children and adolescents with severe conduct problems and elevated CU traits show distinct genetic, cognitive, emotional, biological, environmental, and personality characteristics that seem to implicate different etiological factors underlying their behavior problems relative to other youths with severe conduct problems. Recognizing these subgroups could be critical for guiding future research on the causes of severe conduct problems in children and adolescents. Further, children and adolescents with both severe conduct problems and elevated CU traits appear to be at risk for more severe and persistent antisocial outcomes, even controlling for the severity of their conduct problems, the age of onset of their conduct problems, and common comorbid problems, which supports the clinical importance of designating this group in diagnostic classification systems. Finally, although children and adolescents with both severe conduct problems and elevated CU traits tend to respond less positively to typical interventions provided in mental health and juvenile justice settings, they show positive responses to certain intensive interventions tailored to their unique emotional and cognitive characteristics.(PsycINFO Database Record (c) 2013 APA, all rights reserved).
Distinguishing primary and secondary variants of callous-unemotional traits among adolescents in a clinic-referred sample. - Psychological assessment
The current study used model-based cluster analyses to determine if there are 2 distinct variants of adolescents (ages 11-18) high on callous-unemotional (CU) traits that differ on their level of anxiety and history of trauma. The sample (n = 272) consisted of clinic-referred youths who were primarily African American (90%) and who came from low-income families. Consistent with hypotheses, 3 clusters emerged, including a group low on CU traits, as well as 2 groups high on CU traits that differed in their level of anxiety and past trauma. Consistent with past research on incarcerated adults and adolescents, the group high on anxiety (i.e., secondary variant) was more likely to have histories of abuse and had higher levels of impulsivity, externalizing behaviors, aggression, and behavioral activation. In contrast, the group low on anxiety (i.e., primary variant) scored lower on a measure of behavioral inhibition. On measures of impulsivity and externalizing behavior, the higher scores for the secondary cluster were found only for self-report measures, not on parent-report measures. Youths in the primary cluster also were perceived as less credible reporters than youths in the secondary cluster (i.e., secondary variant) or cluster low on CU traits. These reporter and credibility differences suggest that adolescents within the primary variant may underreport their level of behavioral disturbance, which has important assessment implications.

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