Karl Tomm’s Internalized Other Interviewing: From Theory to Practice

Over the last 40 years, the Canadian psychiatrist and family therapist Karl Tomm has been a key contributor to postmodern developments in family therapy (Collins & Tomm, 2009; Strong et al., 2008; Tomm, Hoyt, & Madigan, 2001). This dissertation traces the people, ideas, and practices that have influenced Tomm\u27s approach, providing an in- depth examination of the method he developed for putting his ideas into practice: Internalized Other Interviewing (IOI). A systemic, relational approach to the practice of postmodern family therapy uses language as a means to create change. Family therapists routinely use different types of questions to ask clients about other people in their lives. Direct, information-seeking questions privilege objectivity, whereas interpersonal perception questions privilege subjective assumptions and allow for new possibilities to arise. The IOI approach offers a third way to ask questions that privilege subject-dependent assumptions and embodied knowledge (K. Tomm, personal communication, August 15, 2019). By inviting clients to speak from their experience of the other, therapists gain entry to a broader base of knowledge.Grounded in social constructionism and bringforthism (Strong et al., 2008; Tomm, 1999, 2002, 2014b), IOI has remained relatively unrecognized and underutilized in clinical work. To date, the theoretical underpinnings and historical development of IOI have not been thoroughly delineated. This dissertation provides the necessary background information and detailed examples for therapists to put the practice in context.Archival information about case examples collected during and following the author\u27s externship at the Calgary Family Therapy Centre in August 2019 have been interwoven throughout the manuscript. These case descriptions, along with Karl Tomm\u27s reflective thoughts, are used to illustrate and illuminate the theory and practice of IOI, bringing to life Tomm\u27s inimitable way of working systemically with individuals, couples, and families

The validity of the test of memory malingering (TOMM) with deaf individuals.

OBJECTIVE: Administration of performance validity tests (PVT) during neuropsychological assessments is standard practice, with the Test of Memory Malingering (TOMM) being a commonly used measure. The TOMM has been well validated in hearing populations with various medical and psychiatric backgrounds. A major gap in the literature is the use of the TOMM amongst culturally Deaf individuals who use American Sign Language (ASL) as their first and preferred language. The purpose of this study was to explore the use of the TOMM with this population to determine if there may be differences related to the use of semantic knowledge and recall using signs rather than spoken phonemes. METHOD: This study recruited 30 culturally Deaf, community-dwelling adults, who self-reported that they were not involved in litigation ordisability claims. In addition to the TOMM, participants were screened for cognitive ability using non-verbal components of the Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II) and the Mini Mental State Examination: ASL Version (MMSE:ASL). RESULTS: Nonverbal intelligence for this sample was within the average range of ability. No participants scored lower than the standard cut-off score for Trial 2 or the Retention Trial on the TOMM (≤44 raw score to indicate invalid responding). Trial 1 performances ranged from 44 to 50, Trial 2 performances ranged from 49 to 50, and Retention performances ranged from 49 to 50. CONCLUSION: These results support the use of the same standard cut-off scores established for hearing individuals in culturally Deaf individuals who use ASL

Exploring the Prevalence of Suboptimal Effort Among Children and Adolescents on Psychoeducational Evaluations

This study represents one of the first known studies to explore suboptimal effort in children and adolescents as part of psychoeducational evaluations conducted within a school setting. Only recently has attention been given to pediatric performance validity testing. With the assistance of five credentialed school psychologists across two midwestern states, 52 students were administered the Test of Memory Malingering (TOMM) as part of their psychoeducational evaluation. The findings of the current study suggested that 19.2% of these students failed Trial 2 on the TOMM, a suggested indicator of suboptimal performance. Furthermore, school psychologists’ ratings of observed effort did not correlate with failure on Trial 2 of the TOMM and there were no discernible patterns across disability area. Full scale ability scores provided a good predictor of performance on the TOMM. Overall, the findings from this study suggest the importance of including an objective performance validity measure for school psychologists in order to improve their ability to identify students who might be demonstrating suboptimal performance. Additional implications for practice and research are provided

Mitochondrial Function Is Required for Secretion of DAF-28/Insulin in C. elegans

While insulin signaling has been extensively studied in Caenorhabditis elegans in the context of ageing and stress response, less is known about the factors underlying the secretion of insulin ligands upstream of the insulin receptor. Activation of the receptor governs the decision whether to progress through the reproductive lifecycle or to arrest growth and enter hibernation. We find that animals with reduced levels of the mitochondrial outer membrane translocase homologue TOMM-40 arrest growth as larvae and have decreased insulin signaling strength. TOMM-40 acts as a mitochondrial translocase in C. elegans and in its absence animals fail to import a mitochondrial protein reporter across the mitochondrial membrane(s). Inactivation of TOMM-40 evokes the mitochondrial unfolded protein response and causes a collapse of the proton gradient across the inner mitochondrial membrane. Consequently these broadly dysfunctional mitochondria render an inability to couple food abundance to secretion of DAF-28/insulin. The secretion defect is not general in nature since two other neuropeptides, ANF::GFP and INS-22::VENUS, are secreted normally. RNAi against two other putative members of the TOMM complex give similar phenotypes, implying that DAF-28 secretion is sensitive to mitochondrial dysfunction in general. We conclude that mitochondrial function is required for C. elegans to secrete DAF-28/insulin when food is abundant. This modulation of secretion likely represents an additional level of control over DAF-28/insulin function

FreeSurfer vs. Manual Tracing: Distinguishing Stable from Cognitively Declining Elders Using Prospectively Measured Hippocampal Volume

Objective: Alzheimer’s disease (AD) pathology is thought to begin years before symptom onset. Hippocampal volume is sensitive to age-related cognitive decline and conversion from MCI to AD. Measurement of hippocampal volumes has used either automated methods such as FreeSurfer (FS) or manual tracing (MT). We compared the ability of FS and MT in detecting baseline volume differences in cognitively intact older individuals who subsequently showed significant cognitive decline. Participants and Methods: Seventy-five cognitively intact elders underwent baseline and 18-month follow-up structural MRI scan and neuropsychological testing. Participants were classified as Declining (n=27) or Stable (n=48) based on the baseline to 18-month changes on a listlearning task and a measure of general cognitive functioning. A 2 (left, right) x 2 (anterior, posterior) x 2 (Declining, Stable) repeated measures ANOVA was conducted for both the MT and FS hippocampal volumes derived at baseline. Results: MT identified significantly smaller left and right hippocampal volumes and smaller anterior than posterior hippocampal volumes in Declining compared to Stable subjects. In contrast, no group differences in hippocampal volumes were observed using FS. Notably, MT included more subiculum and entorhinal cortex, while FS included more of the amygdala and the CA region of the hippocampus. Conclusions: MT was superior to FS for detecting prospective volumetric differences associated with cognitive decline in cognitively intact older participants. MT afforded more unique coverage of the anterior hippocampus than FS. The differences in regional coverage of the mesial temporal lobe between MT and FS may account for the different findings in discriminating Stable and Declining groups

The Detection Of ADHD Malingering Among College Students: A New Look At Figure Drawings

There has been a significant increase in the number of college students feigning symptoms of ADHD. Students can receive a variety of accommodations when diagnosed with ADHD, along with the possibility of medication. These perceived benefits can make a diagnosis of ADHD desirable for college students. Research has found that college students can successfully feign ADHD with minimal detection, leading to improper diagnosis and potential misuse of accommodations and prescription medication. The research indicates a need for new approaches to the detection of ADHD malingering among college students. The present study was exploratory in nature, seeking to identify drawing features on a modified, app-based version of the House-Tree-Person (House-Tree-Person-Modified: HTPM) that could differentiate college students feigning ADHD symptoms from honest responders. The app was created to increase the accuracy of quantifying various measures, such as line pressure, erasures, and black-to-white ratio. The Test of Memory Malingering (TOMM) and the Rey 15 Item Memorization Task (FIT) were utilized to assess for feigned performance, along with the Millon Clinical Multiaxial Inventory, Fourth Edition (MCMI-IV) to assess for profile variations between individuals feigning ADHD symptoms and honest responders. Forty-four participants were included in study. Results of the t-tests found that participants feigning ADHD drew significantly less details than those honestly responding. No other drawing variables were significant. Both the FIT and the TOMM were statistically significant, with the TOMM providing excellent sensitivity and specificity between the honest responders and the participants feigning ADHD symptoms. All but two MCMI-IV variables were statistically different between the honest responders and the participants feigning ADHD. Cut off scores are suggested for TOMM and the MCMI-IV to maximize the potential use of these tools to aid in the assessment of feigned performance of ADHD symptoms among college students. Future research is needed to replicate the current findings for the TOMM and MCM-IV as well as assess other ways to detect feigned performance of ADHD by college students

APPLYING REACTION TIME (RT) AND EVENT-RELATED POTENTIAL (ERPS) MEASURES TO DETECT MALINGERED NEUROCOGNITIVE DEFICIT

This study examined the ability of reaction time (RT) and Event-Related Potentials (ERP) to detect malingered neurocognitive deficit (MNCD)in two new tasks compared to the TOMM (N = 47). Honest (HON), malingering (MAL), and traumatic brain injury (TBI) groups were compared on accuracy, RT and ERP measures. Overall, the Test of Memory Malingering (TOMM) accuracy was the most effective at classifying groups (hit rate = 100%). Several non-TOMM accuracy variables and RT variables reached hit rates in the range of 71%-88%. The TOMM RT variable had an unlimited time for participants to respond and was the most successful RT variable compared to the Old/New and Repetition Priming tasks that had a short time limit for participants to respond (approximately 1.5 seconds). The classic old/new effect RT pattern was evident for both the HON and TBI groups with significantly faster RTs for old items compared to new items. A logistic regression was employed to see if a RT and/or ERP variable added any unique prediction power in detecting malingering. The frontal-posterior ERP difference score had unique prediction power to detect malingering when classifying MAL vs. TBI (hit rate = 86%). In the Old/New task, ERP responses of HON produced greater activity in the frontal region compared to the posterior region. The opposite trend was found in TBI (posterior activity andgt; frontal) and MAL showed no significant difference

Probable Early-Onset Alzheimer's Disease in an Apolipoprotein E2 Homozygote

Objective: To describe a case of early-onset Alzheimer's disease (AD) in an apolipoprotein (Apo) epsilon 2/epsilon 2 homozygote. Background: Apo epsilon 2/epsilon 2 is the rarest of the ApoE genotypes, representing only 1.4% of the population. Cognitive decline in ApoE epsilon 2 homozygotes has rarely been reported. Case Report/Methods: We report a 58-year-old Apo epsilon 2/epsilon 2 female who meets clinical criteria for probable AD as confirmed by neuropsychological testing, positron emission/computed tomography scan, CSF analysis and genetic screening for known mutations. Results: The clinical course is typical of AD, with progressive cognitive and functional decline. Conclusion: Clinically confirmed early-onset AD is atypical in ApoE2 homozygotes but can occur. Copyright (C) 2010 S. Karger AG, Base