HOfstra Horizons - Spring 2020

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H O F S T R A

HORIZONS SPRING 2020

Applying Psychological Science to Improve Work Environments, Home Environments, and Overall Mental Health

RESEARCH AND SCHOLARSHIP PROMOTING EXCELLENCE IN TEACHING AT HOFSTRA UNIVERSITY


president’s COLUMN

HOFSTRAhorizons Research and Scholarship at Hofstra University

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n times of need and in times of crisis, the Hofstra community always pulls together. A few short months ago, no one could have imagined that we would find ourselves in a worldwide pandemic. The global implications of COVID-19 have affected every aspect of our lives, and those implications are still evolving. At Hofstra, our students remain our top priority. Moving quickly to online platforms and remote classes, our faculty and administration continue to provide our students with exceptional learning experiences, resources, and services. It is with great pride that I introduce this issue of Hofstra Horizons, which highlights not only the teaching excellence of our psychology faculty but also their excellence in research and scholarship. Research and scholarship complement and enrich teaching and enable the exploration of new concepts and designs. In these challenging times, it is more important than ever to collaborate and fulfill Hofstra’s mission and goals. We look forward to the time when we can be together to celebrate the milestones and achievements of our students and faculty.

table of contents

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Workplace Ostracism: People’s Psychological Attributions and Coping Strategies

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Family Responsibilities Discrimination: Does Using LinkedIn to Screen Job Candidates Bias Hiring Decisions?

I applaud the research of our faculty, and I thank you for supporting them, especially in these uncertain times. Sincerely, Stuart Rabinowitz, JD President

Stuart Rabinowitz, JD President, Hofstra University

Herman A. Berliner, PhD Provost and Senior Vice President for Academic Affairs Margaret Abraham, PhD Senior Vice Provost for Academic Affairs Sofia Kakoulidis, MBA Associate Provost for Research and Sponsored Programs Alice Diaz-Bonhomme, BA Assistant Provost for Research and Sponsored Programs

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provost’s COLUMN

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he Janus Project: T Future Self and Psychopathology

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A Look Toward the Future of Treating Psychiatric Disorders

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The Effects of a Home-Based Intervention Conducted by College Students for Young Children With Developmental Delays in Vietnam

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Faculty Research

HOFSTRA HORIZONS is published annually by the Office for Research and Sponsored Programs, 144 Hofstra University, Hempstead, NY 11549-1440. Each issue describes in lay language some of the many research and creative activities conducted at Hofstra. The conclusions and opinions expressed by the investigators and writers are their own and do not necessarily reflect University policy. ©2020 by Hofstra University in the United States. All rights reserved. No part of this publication may be reproduced without the consent of Hofstra University. Inquiries and requests for permission to reprint material should be addressed to: Editor, Hofstra Horizons, Office for Research and Sponsored Programs, 144 Hofstra University, Hempstead, NY 11549-1440. Telephone: 516-463-6810.

n these extremely challenging times, Hofstra’s faculty, administration, and students have united in unique and inspiring ways to move forward our shared educational mission. I am proud of our efforts and accomplishments in creating an effective and engaging distance learning environment. Pivotal to this effort is the work of our faculty. I am therefore especially pleased to introduce the newest issue of Hofstra Horizons, which underscores the noteworthy research and scholarship of our psychology faculty. Dr. Cong Liu’s article details the results of studies done on workplace ostracism, a form of workplace mistreatment that threatens employees’ mental health and well-being. Studies indicate that using occupational health psychology may reduce stress and improve employees’ work life quality. The next article details the results of studies conducted by Dr. Kevin Nolan and colleagues on family responsibilities discrimination. This series of studies used heat-mapping software to identify whether employers use information from LinkedIn profiles to evaluate job candidates. Dr. Mark Serper’s article describes work completed as part of the Janus Project, particularly the overlapping roles of an individual’s past, present, and future selves in their self-identity, choices, and behaviors. Dr. Keith Shafritz discusses how his research program combines brain imaging and behavioral testing to diagnose mental disorders more accurately and improve overall success of treatments. Finally, the article written by Dr. Jin Shin examines the effectiveness of home-based intervention services for young children with developmental delays in Vietnam. Dr. Shin’s intervention program showed great promise in improving the functioning of children with developmental delays in low- and middle-income countries. We wrap up this issue of Hofstra Horizons with a list of our psychology faculty and their varied research interests and expertise. I congratulate all the authors on their fine research work and thank them for their commitment to our students. We are proud to spotlight their work in this issue of Hofstra Horizons. Sincerely,

Herman A. Berliner, PhD Provost and Senior Vice President for Academic Affairs Hofstra University Hofstra HORIZONS t Spring 2020

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INTRODUCTION Faculty are the catalyst for the extraordinary research and learning that unfolds at Hofstra College of Liberal Arts and Sciences (HCLAS). As dean of HCLAS, I am consistently impressed with the extraordinary commitment of our faculty to our students’ learning. This is true in all our departments and, as you’ll see in this issue, it’s particularly true of our faculty in the Department of Psychology.

Benjamin Rifkin, PhD Dean of Hofstra College of Liberal Arts and Sciences

It is my honor to share with you a sample of the research conducted by just some of our outstanding faculty in the Department of Psychology, highlighted in this issue of Hofstra Horizons. When you read the articles by our psychology faculty, who specialize in different subfields as reflected in their essays in this issue, you will get a taste of the outstanding research of our Hofstra faculty scholars and more deeply understand the relevance of their work to the challenging circumstances in which we find ourselves in the spring of 2020. Our HCLAS faculty focus on connecting to the wellspring of their disciplines to explore both enduring questions and the burning issues of the day, identifying relationships between the two through the rigorous application of well-proven research methods in their respective disciplines. They present their research at top conferences in their fields and publish their findings in the most prestigious journals, as well as in edited volumes and scholarly books. Our faculty’s research excellence is also recognized annually by the awards and fellowships they receive, including, most recently, NEH and Fulbright fellowships, as well as grants, including major grants from the National Science Foundation, but these recognitions are not where the story ends. In fact, HCLAS faculty scholarship enters their Hofstra classrooms and informs the discussions they have with their students, so that Hofstra students benefit from the latest work, the cutting-edge research, that is shaping their field of study.

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Our HCLAS faculty focus on connecting to the wellspring of their disciplines to explore both enduring questions and the burning issues of the day, identifying relationships between the two through the rigorous application of well-proven research methods in their respective disciplines.

Because HCLAS is the home of general education at Hofstra University, all students – whether they have a major in the liberal arts or in community health, education, engineering, journalism, or management – take courses in the liberal arts to fulfill their general education requirements, a requirement consistent with the educational patterns of the best universities across the country. In this way, the research of our liberal arts faculty has a classroom impact not only on students majoring in the liberal arts, but on all undergraduate students at Hofstra. HCLAS is proud of the innovative new courses and programs we bring forward, the scholarships we award our students to help them participate in transformative learning experiences, the scholarly conference presentations and research publications of our students (made possible by the close mentoring of our outstanding faculty), and the special events organized by our faculty and students to celebrate the arts and sciences on our campus and, in the context of social distancing, virtually. For more information about the exciting news from Hofstra College of Liberal Arts and Sciences, please see our biannual alumni newsletter, available at hofstra.edu/hclas-updates. And please visit the Hofstra University events calendar at events.hofstra.edu to view the many events scheduled for the fall, as we continue to explore the arts and sciences at Hofstra.

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Workplace Ostracism: People’s Psychological Attributions and Coping Strategies Cong Liu, PhD, Professor of Psychology, Hofstra University Inappropriate or stressful working conditions can be tremendously harmful to employees’ well-being. They can cause psychological and physical strains (e.g., anxiety, depression, tense muscles, migraine headaches) and chronic diseases (e.g., hypertension, peptic ulcers). The economic burden of this continuing toll is high. A study revealed $171 billion annually in direct and indirect costs of occupational injuries and illnesses (Leigh, Markowitz, Fahs, Shin, & Landrigan, 1997). This enormous toll can be reduced by using occupational health psychology (OHP). OHP concerns the

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application of psychology to improve the quality of work life, and to protect and promote the health and well-being of workers. A growing body of OHP research has identified workplace mistreatment (e.g., sexual harassment, interpersonal conflicts, abusive supervision) as significant threats to both employee well-being and organizational functioning (Hershcovis, 2011). A subtle yet common workplace mistreatment is workplace ostracism, defined as when people at work omit actions to include other organizational members when it is socially

appropriate to include (Robinson, O’Reilly, & Wang, 2013). Fox and Stallworth (2005) revealed that over a five-year period, 66% of the employees had experienced workplace ostracism. Workplace ostracism has shown stronger detrimental effects on employees’ occupational health than other types of mistreatments, such as sexual harassment and aggression (O’Reilly, Robinson, Berdahl, & Banki, 2014). Workplace ostracism presents an act of omission – the actor withdraws or omits their social interactions with the victim. Other mistreatments


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reflect the act of commission – the actors commit to negative behaviors toward the victim. In addition, the motive behind ostracism could range from no intent (nonpurposeful) to malicious intent (purposeful). Therefore, ostracism could present a lot of ambiguity to the victim. A victim may not know why it is happening, or if it is indeed happening. The victim will engage in cognitive processes to make sense of the incident. Attributions refer to the causal explanations used by individuals to interpret the world around them, particularly when the events are important and negative (Weiner, 1985). Individuals attempt to distinguish between internal (self) and external (outside of self) explanations. Internal attributions refer to the extent to which people place the cause of the observed behavior on an internal force (i.e., self-blame; Weiner, 1985). External attributions refer to the extent to which people place the cause of the observed behavior on some outside force, such as the behavior initiator (i.e., other-blame; Weiner, 1985). Internal and external attributions are not mutually exclusive (Hershcovis & Barling, 2010). Perceived harming intent reflects the victim’s perception of the actor’s motive behind ostracism. Victims will use this perception to make internal and external attributions and decipher the ostracism episode (Kelley & Michela, 1980). When the perceived harming intent is low, victims experience nonpurposeful ostracism. For example, this could happen quite often with international students in school settings. The local students may simply engage in a topic they are familiar with or form a social group with similar others. The international students may feel left out due to language barrier or

cultural dissimilarity. According to the social information processing model (Crick & Dodge, 1994), victims will rely on social cues to make attributions. When the perceived harming intent is low and the social cues are ambiguous, victims of ostracism are not able to easily determine the causality. They may turn to themselves, examining whether they have done something wrong (e.g., social awkwardness, inappropriate behavior, lack of knowledge, selfishness) that elicited the ostracism. Ambiguous ostracism could elicit such self-doubt, and selfdoubt is highly intertwined with selfblame (McCormack, Abou-Hamdan, & Joseph, 2017). Consequently, these victims are more likely to place internal locus of causality and blame themselves (Figure 1). On the other hand, there may be two underlying motives for purposeful ostracism (Robinson et al., 2013). First, an actor may purposefully ostracize another person in order to protect oneself. After some interpersonal infractions, the actor may shun away from the victim in order to avoid more conflict, social awkwardness, or negative emotions. Second, an actor

Workplace ostracism has shown stronger detrimental effects on employees’ occupational health than other types of mistreatments ...

may intend to harm the victim using the silent treatment. From the victim’s perspective, purposeful ostracism violates the norms of respect and threatens their self-worth. Since people have a general tendency to protect their self-image and promote their self-worth (Jones & Davis, 1965), with a slight sign of harming intent, victims will make external attributions and blame others (Figure 1).

Figure 1: The Research Model for Study 1 & Study 2 Perceived Harming Intent

Self-Esteem Internal Attribution

Workplace Ostracism External Attribution

Psychological Strains Physical Strains

Absence

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Internal and external attributions of ostracism will have different detrimental effects on the victims. Based on self-verification theory (Ferris, Lian, Brown, & Morrison, 2015), individuals rely on their past experiences to make conclusions about others’ behaviors toward them. Internal attributions of ostracism may reflect negative past experiences. For example, an individual who has been told that they talk too much might attribute avoidance to the individual being talkative. Being ostracized signals to individuals that something about them is undesirable (Lustenberger & Jagacinski, 2010). As such, internal attributions of workplace ostracism determine the decrements in one’s self-esteem. Low self-esteem may further relate to a downward spiral of perceiving more ostracism and experiencing more strains. On the other hand, external attribution may not reflect negative past experience about the victims, because the locus of causality is outside of oneself. Thus, the victim’s self-esteem is protected. Taken together, internal attribution of ostracism verifies negative selfperceptions and is more detrimental than external attribution (Figure 1).

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We conducted two studies that provided support to the research model presented in Figure 1.

Study 1. Ostracism Experienced by International Students in School Settings International students in the United States comprise a growing body of the population. It is not uncommon for international students to experience and feel exclusion or ostracism (Searle & Ward, 1990). Therefore, in the first study we recruited 150 international students. On average, they had spent 19.63 months in the United States. The majority of the international students were from China (91) and India (34). The rest were from Bangladesh, Brazil, Iran, Japan, Jordan, Malaysia, Mexico, Nepal, Nigeria, Spain, Sri Lanka, and Uganda. We found that school ostracism significantly interacted with perceived harming intent in predicting internal attribution, ∆R2 =.04, F(1, 148) = 6.77, p = .01. As shown in Figure 2a, ostracism was more positively related to internal attribution when perceived harming intent was low rather than high. Internal attribution was also more strongly related to self-esteem, t(df = 150) = -1.69, p < .05, than external attribution.

Study 2. Ostracism Among Employees in Work Settings In Study 2, I collected data and tested the ostracism model with a sample of 403 full-time employees. The participants were from a variety of industries, such as education, financial services, food services, government agencies, health care, information technology, manufacturing, media/ entertainment, consulting, retail, etc. The interaction term of ostracism and perceived harming intent explained a significant increase of variance in internal attribution, ∆R2 =.02, F(1, 397) = 7.64, p = .006. Figure 2a shows ostracism was more strongly related to internal attribution when perceived harming intent was low, compared to when perceived harming intent was high. With nonpurposeful ostracism, the victims placed more self-blame and less other-blame. The interaction term of ostracism and perceived harming intent significantly predicted external attribution, ∆R2 =.02, F(1, 397) = 8.94, p = .003. When perceived harming intent was low, ostracism negatively predicted external attribution; when perceived harming intent was high, ostracism


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Figure 3: The Research Model for Study 3

Employees’ Harmony Enhancement Value

Supervisor Ostracism

Employee Depression

Employees’ Disintegration Avoidance Value

positively predicted external attribution (Figure 2b). With purposeful ostracism, the victims put strong blame on the actors. They also slightly blamed themselves. Internal attribution was more strongly related to self-esteem, t(df = 233) = -2.48, p <.01, psychological strains, t(df = 233) = 2.49, p <.01, physical strains, t(df = 233) = 2.07, p <.01, and absence, t(df = 219) = 1.87, p < .05, than was external attribution. These long-term nonpurposeful ostracism behaviors could be very harmful to employees’ self-esteem, psychological strains, physical strains, and absence, through more self-blame. It verifies that being socially ostracized threatens people’s fundamental need for belonging and need for self-esteem. Harmful motivation does not need to present in order to hurt people. The act of omission itself carries deleterious functioning. For actors of nonpurposeful ostracism, this act of omission may seem naïve and harmless. However, the detrimental effect on the victims cannot be ignored. Speaking practically, these nonpurposeful ostracisms could be easily prevented by reminding the actors to be aware

of their act of omission and to be more inclusive. In work settings, reminding employees to be more collegial or team-oriented may be an easy strategy to boost team cohesion.

Study 3. Workplace Ostracism From One’s Supervisor Ostracism from one’s supervisor is particularly detrimental to employees’ psychological health due to the hierarchical difference between the two parties. In coping with supervisor ostracism, employees’ relationship-oriented values and behavior tendencies would be helpful. People have two social motives in maintaining interpersonal harmony (the dualistic model of interpersonal harmony, Leung & Brew, 2009): 1) H armony enhancement reflects a motive that promotes high-quality relationships through proactive behaviors for open discussions. 2) D isintegration avoidance reflects a social motive to avoid negative consequences of a strained relationship. Albeit with a common harmonious goal, these two social motives could relate to opposite outcomes (Elliot, 2006; Gable, 2006). First, harmony enhancement originates from classical Confucianism in ancient China. Employees endorsing high harmony enhancement genuinely care about high-quality interpersonal relationships. They treat others as positively resourceful. When experiencing workplace ostracism from their supervisors, these employees have

a tendency to adopt active and effortful approaches and engage in constructive interpersonal behaviors to reconcile disagreements. Through effortful social behaviors, they have a better chance to clarify the situation and/ or solve the interpersonal problems. Compared to their low-harmony enhancement counterparts, employees high in harmony enhancement would be less likely to experience depression after supervisor ostracism than employees low in harmony enhancement (Figure 3). Second, because confrontations may lead to negative social exchanges and negative emotions, people also cope with conflict by distancing themselves from the conflictual parties (Duffy, Shaw, & Stark, 2000). People high in disintegration avoidance are sensitive to negative consequences of strained relationships, such as supervisoremployee relationships. They show behavioral tendency to passively detach themselves from unfavorable relationships in hoping this will lead to the weakening and dissolving of a problem on its own. Although harmony-oriented, they are motivated by an avoidance approach, which could further distance them from the supervisor-employee relationship. The temporary cooling off may escalate into strong perceptions of ostracism by both parties. Thus, employees high in disintegration avoidance may experience more depression after supervisor ostracism than employees low in disintegration avoidance (Figure 3). We collected data from 449 employees and 135 supervisors at three time waves from a Chinese airline company. We found that the moderating effect of employee harmony enhancement was significant on the relationship between supervisor ostracism and employee

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depression (y=-.26, p<.01). As shown in Figure 4, supervisor ostracism was more strongly related to depression for employees low in harmony enhancement than for employees high in harmony enhancement. The moderating effect of employee disintegration avoidance was also significant for supervisor ostracism in relation to depression (y=.31, p<.05). As shown in Figure 5, supervisor ostracism was more strongly related to depression for employees high in disintegration avoidance than for employees low in disintegration avoidance. To conclude, employees high in harmony enhancement are more proactive in interpersonal interactions. These qualities help them more effectively cope with workplace mistreatments and suffer less depression. On the other hand, employees’ disintegration avoidance value exacerbated supervisor ostracism in relation to employee depression. Although employees high in disintegration avoidance value peaceful relationships, the avoidance behavior could be harmful to their own performance and health. When

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left unchecked, ostracism and related consequences could intensify over time. The concepts of harmony enhancement and disintegration avoidance are based on the indigenous research in China. They have also been validated in Western societies, such as Australia and the United States (Leung, Brew, Zhang, & Zhang, 2011; Liu, Nauta, Yang, & Spector, 2018). Understanding harmony enhancement and its functions could help employees move outside of their comfort zone in coping with supervisor ostracism. With the prevalence of more diversified workplace teams, harmony enhancement and the philosophy behind it could provide guidance to team member interactions. On the other hand, we remind employees that their disintegration avoidance value and behaviors could backfire and harm their mental health.

and satisfaction in conflicted interdependent groups: When and how does self-esteem make a difference? Academy of Management Journal, 43(4), 772-782. Elliot, A. J. (2006). The hierarchical model of approach-avoidance motivation. Motivation and Emotion, 30(2), 111-116. Ferris, D. L., Lian, H., Brown, D. J., & Morrison, R. (2015). Ostracism, selfesteem, and job performance: When do we self-verify and when do we self-enhance? Academy of Management Journal, 58(1), 279-297. doi:10.5465/ amj.2011.0347 Fox, S., & Stallworth, L. E. (2005). Racial/ethnic bullying: Exploring links between bullying and racism in the US workplace. Journal of Vocational Behavior, 66(3), 438-456. Gable, S. L. (2006). Approach and avoidance social motives and goals. Journal of Personality, 74(1), 175-222.

References Crick, N. R., & Dodge, K. A. (1994). A review and reformulation of social information-processing mechanisms in children’s social adjustment. Psychological Bulletin, 115(1), 74-101.

Hershcovis, M. S. (2011). “Incivility, social undermining, bullying…oh my!”: A call to reconcile constructs within workplace aggression research. Journal of Organizational Behavior, 32(3), 499-519. doi:10.1002/job.689

Duffy, M. K., Shaw, J. D., & Stark, E. M. (2000). Performance

Hershcovis, M. S., & Barling, J. (2010). Comparing victim attributions and


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outcomes for workplace aggression and sexual harassment. Journal of Applied Psychology, 95(5), 874-888. doi:10.1037/a0020070

Chiu, & Y. Hong (Eds.), Understanding culture: Theory, research, and application (pp. 411-428). New York, NY: Psychology Press.

Jones, E. E., & Davis, K. E. (1965). From acts to dispositions: The attribution process in person perception. In L. Berkowitz (Ed.), Advances in Experimental Social Psychology (Vol. 2, pp. 219-266). New York, NY: Academic Press.

Leung, K., Brew, F. P., Zhang, Z.-X., & Zhang, Y. (2011). Harmony and conflict: A cross-cultural investigation in China and Australia. Journal of CrossCultural Psychology, 42(5), 795-816.

Kelley, H. H., & Michela, J. L. (1980). Attribution theory and research. Annual Review of Psychology, 31(1), 457-501. Leigh, J. P., Markowitz, S. B., Fahs, M., Shin, C., & Landrigan, P. J. (1997). Occupational injuries and illness in the United States. Archives of Internal Medicine, 157, 1557-1568. Leung, K., & Brew, F. P. (2009). A cultural analysis of harmony and conflict: Toward an integrated model of conflict styles. In R. S. Wyer, C.

Liu, C., Nauta, M. M., Yang, L. Q., & Spector, P. E. (2018). How do coworkers “make the place”? Examining coworker conflict and the value of harmony in China and the United States. Applied Psychology: An International Review, 67(1), 30-60. Lustenberger, D. E., & Jagacinski, C. M. (2010). Exploring the effects of ostracism on performance and intrinsic motivation. Human Performance, 23(4), 283-304. McCormack, L., Abou-Hamdan, S., & Joseph, S. (2017). Career derailment:

Burnout and bullying at the executive level. International Coaching Psychology Review, 12(1), 24-36. O’Reilly, J., Robinson, S. L., Berdahl, J. L., & Banki, S. (2014). Is negative attention better than no attention? The comparative effects of ostracism and harassment at work. Organization Science, 26(3), 774-793. Robinson, S. L., O’Reilly, J., & Wang, W. (2013). Invisible at work. Journal of Management, 39(1), 203-231. doi:10.1177/0149206312466141 Searle, W., & Ward, C. (1990). The prediction of psychological and sociocultural adjustment during cross-cultural transitions. International Journal of Intercultural Relations, 14(4), 449-464. Weiner, B. (1985). An attributional theory of achievement motivation and emotion. Psychological Review, 92(4), 548-573.

Cong Liu is a professor of psychology and director of the PhD Program in Applied Organizational Psychology at Hofstra University. She serves as associate editor of the International Journal of Stress Management. Liu’s research lies in the field of occupational health psychology (OHP), which focuses on the application of psychology in the workplace to improve the quality of work life, workplace relationships, and employees’ psychological and physical health. She has three main lines of research. First, she studies workplace mistreatments, examining social stressors, such as workplace ostracism, interpersonal conflict at work, and abusive supervision. Second, she is interested in the dual-process model of challenge and hindrance stressors, focusing on cognitive appraisals and the differential impact of challenge and hindrance stressors on employees’ health and work performance. Third, her recent projects are designed to examine family outcomes such as marital satisfaction and parent-child relationships resulting from dual roles: Work versus family roles, or administrative versus professional roles. She has published in the Journal of Applied Psychology, Journal of Management, Journal of Organizational Behavior, Journal of Occupational and Organizational Psychology, Work & Stress, Journal of Occupational Health Psychology, Applied Psychology: An International Review, and International Journal of Stress Management. Liu is an active member of the Long Island Chinese American Association (LICAA). She has been doing volunteer work for LICAA since 2014. Her efforts aim to bridge the local Chinese community with the mainstream community, to introduce Chinese culture to Americans, and to help community leaders create diversified work and living places for the new generations. She received the Outstanding Volunteer Award from the Town of Oyster Bay.

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Family Responsibilities Discrimination: Does Using LinkedIn to Screen Job Candidates Bias Hiring Decisions? Kevin P. Nolan, PhD, Associate Professor of Psychology, Hofstra University Each month, more than 5 million hiring decisions are made in the United States of America that affect the lives of workers and the organizations that employ them (Bureau of Labor Statistics, 2018). It has become increasingly common for organizations to use LinkedIn to recruit and screen job candidates. LinkedIn is the largest professional network on the internet, with over 500 million users worldwide, and a survey of HR professionals found that nearly 95% of employers use LinkedIn to make hiring decisions (Karl & Peluchette, 2013). This level of popularity has led some to conclude that LinkedIn 12

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profiles have largely replaced more traditional resumes (Zide, Elman, & Shahani-Denning, 2014). Unlike traditional resumes, however, LinkedIn profiles commonly contain a variety of non-job-related information (e.g., profile pictures, influencers followed) that can introduce unwanted biases into personnel selection (Roth, Bobko, Van Iddekinge, & Thatcher, 2013). The potential for this information to include profile features indicative of family responsibilities is noteworthy, given the prevalence of community groups/interests on LinkedIn pertaining to parenthood (e.g., Work-From-Home-Moms,

19,905 members; LinkedIn, 2018). Family Responsibilities Discrimination (FRD) is widely considered the hot topic in employment law. It involves discrimination against workers based on their (actual or perceived) responsibilities to care for family members. Under a combination of Title VII, the Americans with Disabilities Act, and state antidiscrimination laws, both women and (to a lesser extent) men have successfully sued employers for disparate treatment relating to caregiver bias. FRD, however, remains a lesser known form of discrimination among employers,


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with a review of case law suggesting that many employers surprisingly believe that caregiver responsibilities are valid criteria to consider when making employment decisions (Albiston, Dickson, Fishman, & Levy, 2007). Caregiver bias is understood to result from perceived incongruity between the communal traits that are stereotypically ascribed to caregivers and the agentic traits that are stereotypically ascribed to work, with parenthood having a particularly deleterious effect on women, as it increases the salience of beliefs about prototypically female attributes (Heilman, 2001). Research on FRD has primarily examined the effects of implicit caregiver bias on promotion decisions involving job incumbents with known parental responsibilities for traditionally male-gender-typed jobs (e.g., prison guard). Decision making for personnel selection, however, is particularly susceptible to employers’ idiosyncratic beliefs and biases during the initial stages of hiring because they tend to rely on categorybased, stereotypical information processing when limited information is available about candidates (Derous, Pepermans, & Ryan, 2017). To examine the extent to which employers (i.e., those who make hiring decisions) consider information from LinkedIn profiles that is indicative of family responsibilities (FR information) when using “expert” judgment to screen external (i.e., non-incumbent) job candidates, my colleagues1 and I conducted a series of studies that used heat-mapping software to answer the following questions:

1. Will employers explicitly report using FR information to evaluate job candidates? 2. Does using FR information to evaluate job candidates adversely affect employers’ judgments of their well-suitedness for work? 3. Are employers more likely to use FR information to evaluate female job candidates than male job candidates? 4. Are female employers less likely to use FR information to evaluate job candidates than are male employers? 5. Are employers more likely to use FR information to evaluate job candidates when a fast-paced/ competitive (i.e., agentic) organizational culture is emphasized in the hiring context?

LinkedIn profiles commonly contain a variety of non-job-related information (e.g., profile pictures, influencers followed) that can introduce unwanted biases into personnel selection.

Study 1 Methodology A sample of N=245 American workers with self-reported experience using LinkedIn to make hiring decisions Table 1. LinkedIn Information Communicating Family Responsibilities LinkedIn Zone

Description

background8

Positions offering the opportunity to work from home are of interest

experience24

Great at balancing work and family

orgs2

Boy Scouts of America Den Leader

orgs3

New York State Parent Teacher Association Member

orgs4

Little League Baseball Assistant Coach

groups3

The Working Mother (Father)

groups4

Work Life Balance

groups5

Youth in Transition

groups6

Mom (Dad) Entrepreneurs

interests4

Parenting issues

interests5

College admissions

interests6

Youth swim camp

1 Dr.

Comila Shahani-Denning is a professor of psychology in Hofstra College of Liberal Arts and Sciences and director of the MA in Industrial-Organizational Psychology Program. Aditi Sachdev earned an MA in Industrial-Organizational Psychology from Hofstra University and is a doctoral candidate in the PhD in Applied Organizational Psychology Program at Hofstra University. Isabela Araujo earned a BA in Psychology and General Business from Hofstra University and is pursuing an MS in Social and Organisational Psychology from The London School of Economics and Political Science.

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participated in the study. Participants were first asked to read a job posting for a sales manager position. Half the participants were randomly assigned to a job posting that used 17 pieces of symbolic information to describe a fast-paced/competitive work environment (high emphasis on an agentic culture), whereas the other half were assigned to a posting that was commensurate in overall word count, but only contained three pieces of symbolic information describing the culture (low emphasis) (see Figure 1). Both postings contained the same job title, responsibilities, qualifications, and compensation. After reading the job posting, participants were randomly assigned to review the LinkedIn profile of either a male or female job candidate. Aside from the candidates’ names, profile pictures, and use of gender pronouns, the information presented in the profiles was identical. Participants were then asked to report their beliefs about the candidate’s overall wellsuitedness for the position, and identify all the information from the LinkedIn profile (both good and bad) that they used to form their evaluations. This exercise was completed using a custombuilt 74-zone heatmap overlaid atop the LinkedIn profiles (see Figure 2). A pilot study conducted using N=25 industrialorganizational psychology graduate students identified 12 of these zones as containing FR information. Participants’ use of FR information to evaluate candidates was operationalized as the percentage of total information identified that came from zones indicative of family responsibilities. Findings Overall, 35.1% of participants openly reported using FR information (e.g., New York State Parent Teacher Association Member) to evaluate candidates’ well-suitedness for the positon, with the amount of FR

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Figure 1: Job Posting Company Overview *** (More information about organizational culture)*** Insight International is an industry-leading retail service provider with an achievement-oriented approach to business. We attribute the success of our organization to hardworking, dedicated employees who are never satisfied with the status quo. At Insight International, we embrace our focused and exacting approach to business. Our mission is to provide top-quality services to retail stores all over the world. To realize this vision, we need creative workers who are capable of thinking outside of the box. As our company continues to grow, we are looking for ambitious go-getters who will thrive in an exciting, fast-paced work environment. If you are an innovative person who is driven by personal accomplishment and dedicated to success, then we encourage you to apply. Company Overview *** (Less information about organizational culture)*** Insight International is an industry-leading retail service provider with a straight-forward approach to business. Having firmly established ourselves in North America and South America, our goal is to extend the full range of our services to retail stores in Europe, Asia, and Africa by 2020. To realize this vision, we need to expand our workforce. Insight International is looking to hire a variety of skilled workers who will thrive in our organization’s unique work environment. If you have experience with sales and are looking for an opportunity to further develop yourself professionally, then we encourage you to apply. Applications will be processed in the order in which they are received. Position Description Job Title: • Sales Manager (Full-time Employee) Responsibilities: • Resolve customer complaints regarding sales and service. • Oversee regional and local sales associates. • Plan and direct staffing, training, and performance evaluations to develop and control sales and service programs. • Determine price schedules and discount rates. • Review operational records and reports to project sales and determine profitability. • Monitor customer preferences to determine focus of sales efforts. • Prepare budgets and approve budget expenditures. • Confer with department heads to coordinate sales and marketing opportunities. • Direct activities involving sales of manufactured products, services, commodities, real estate or other subjects of sale. • Confer with potential customers regarding service needs and advise customers on which services to purchase. • Be accessible to sales associates at any time that they may need assistance. • Measure performance of sales associates using multiple indicators and manage that performance accordingly. • Interpret company handbook to direct sales associates’ inquiries as they relate to policy. Qualifications: Preferred candidates: • Have excellent leadership and communication skills. • Hold a Master’s degree in Business or a related field. • Are capable of effectively managing a dynamic group of sales professionals. • Possess strong analytical and decision-making skills. • Are able to work at a fast-pace and learn products, systems, and sales processes. • Can demonstrate 5+ years of success in sales management or territory sales. Minimum Requirements: • Hold a Bachelor’s degree in business or a related field. • Can demonstrate 2+ years of success in sales management or territory sales. • Can demonstrate strong persuasive skills and excellent sales results. • Must have intermediate computer skills, Microsoft Office Skills and understand how to manipulate large spreadsheets in Microsoft Excel. • Must have experience in interviewing sales associate candidates and terminating employees. Compensation: • Competitive base salary • Bonus pay program that rewards results • Medical, dental, and vision insurance • 401K retirement program with employer match

• Training and development programs that offer tuition assistance • Competitive employee discount program


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information they cited ranging from 5% to 100% (M=26.3%, SD=18.6%) of the total information identified. The amount of FR information used to evaluate job candidates had a significant negative relationship with participants’ ratings of their wellsuitedness for the position (r=-.22, p<.001) – meaning the more FR information participants reported using to evaluate the candidates, the less well-suited they thought they were for the job. Although FR information use was affected by the sex of the candidate, sex of the participant, and level of emphasis place on a fast-paced/ competitive organizational culture, these findings were not as expected. Instead, emphasizing the fast-paced/ competitive work environment was found to have a particularly pronounced effect on female participants who were assigned to evaluate the female job candidate, with the highest use of FR information reported in this condition of the study (see Figure 3). Together, these findings suggest that allowing employers to screen job candidates via subjective evaluation of their LinkedIn profiles exposes hiring decisions to FRD, especially when female candidates are being evaluated by female employers for jobs at organizations with fast-paced/ competitive (i.e., agentic) work environments.

Study 2 In Study 1, approximately one-third of all participants openly reported using information from LinkedIn profiles indicative of family responsibilities to evaluate job candidates. This finding is potentially attributable to the fact that FRD, although illegal in the USA, is a lesser known form of discrimination among employers than those that are explicitly outlined in the federal regulations that govern personnel selection (e.g., age, sex, race). Brazil,

however, has explicit legislation barring workplace discrimination based on family situation that was publicly enacted using a widespread information campaign in 1999. Likewise, Brazil has the third largest population of LinkedIn users and Latin America’s largest economy (Gasparini, 2017). These features make it an interesting crosscultural context in which to further examine the effect of caregiver bias on hiring decisions that are made by subjectively reviewing LinkedIn profiles. Study 1 was therefore replicated using a sample of Brazilian employers with a slight modification to the study’s methodology. Instead of examining the relationship between employers’ use of FR information and their evaluations of job candidates’ overall well-suitedness for the position, evaluations of well-suitedness were delineated into employers’ beliefs about the candidates’ ability to perform job demands (Person-Job Fit) and their fit with the organizational culture (Person-Organization Fit) – both of which have been shown to influence hiring decisions (Lauver & KristofBrown, 2001). Methodology A sample of N=75 Brazilian workers with self-reported experience using LinkedIn to make hiring decisions participated in this study, which had the same basic design and procedure as Study 1. However, rather than completing a global measure of candidates’ well-suitedness for the position after reviewing the job posting and LinkedIn profile, participants completed specific measures of personjob (PJ) and person-organization (PO) fit before being instructed to identify all the information from the LinkedIn profile (both good and bad) that they used to evaluate the candidate. The LinkedIn profiles were modified to accommodate international differences,

but a pilot study of N=46 Brazilian participants suggested that the same zones from the LinkedIn profile that were indicative of family responsibilities in Study 1 were also indicative of family responsibilities in Study 2. Findings Overall, 42.7% of participants openly reported using FR information to evaluate the job candidates, with the amount of FR information they cited ranging from 5% to 100% (M=25.7%, SD=20.5%) of the total information identified. These findings are commensurate with the trends observed in the USA sample in terms of both the proportion of participants explicitly reporting use of FR information to screen candidates and the proportion of total information cited coming from zones indicative of family responsibilities. The amount of FR information participants reported using to evaluate job candidates had a significant negative relationship with their ratings of the candidates’ PO fit (r=-.24, p=.04), but was unrelated to their ratings of PJ fit. These findings suggest that caregiver bias, in this context, may have less to do with employers’ beliefs about parents’ ability to perform job demands than it does with their concerns about parents’ ability to fit in fast-paced/competitive (i.e., agentic) organizational cultures. Again, female participants reported greater use of FR information to evaluate job candidates than their male counterparts, especially when screening female candidates in the context that emphasized the fast-paced/competitive work environment. These findings support the trends observed in Study 1 and suggest that the potential for FRD to result from using LinkedIn profiles to screen job candidates is not an issue that is unique to personnel selection in the USA.

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Figure 2: LinkedIn Profiles (with example heat map overlay)

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Study 3 Research examining implicit caregiver bias in promotion decisions has found that knowledge of family responsibilities can adversely affect evaluations of competence – especially for female candidates (Heilman & Okimoto, 2008). The relationship between FR information use and ratings of PJ fit in Study 2, however, was nonsignificant. Although it is possible that caregiver bias is primarily manifested in evaluations of PO fit when LinkedIn profiles are used to screen external job candidates, it is also possible that the null relationship observed between FR information use and PJ fit in Study 2 was an artifact of the study’s design. Participants who assigned lower ratings of PJ fit may have been less willing to identify FR information as having informed their evaluations than participants who assigned lower ratings of PO fit due to social convention. Subjective

evaluations of PO fit are widely used as surrogates for prejudice and bigotry in personnel selection, with employers regularly denying employment to minority candidates on the grounds that they would not “fit” in their organizations (Guion, 1998). Additionally, the principles of cognitive matching suggest that category-based, stereotypical information processing is highly context dependent (Perry, 1994). Emphasizing a fast-paced/competitive organizational culture may have increased the salience of misfit between family responsibilities and the work environment, resulting in greater identification of information indicative of this form of perceived incongruence when participants were given general instructions to identify information from the LinkedIn profiles that influenced their evaluations of well-suitedness. Study 3 was therefore conducted to examine the extents to which employers would report using FR information to screen candidates under specific instructions to identify all the information from the LinkedIn profile (both good and bad) that influenced their beliefs about the candidate’s (a) ability to perform job demands, and (b) fit with the organizational culture.


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Figure 2: LinkedIn Profiles (with example heat map overlay)

Methodology A sample of N=198 hiring managers/recruiters who work in the USA and use LinkedIn to evaluate job candidates participated in the study, which used the same general design as Study 1. However, after reading the assigned job posting and LinkedIn profile, participants first rated the overall well-suitedness of the candidate for the position. Then, they completed separate PJ and PO fit identification exercises in counterbalanced order. Both exercises started with the same basic instructions, “We are interested in understanding what information from the LinkedIn profile influenced your beliefs about how well-suited the candidate is for the position. Please identify all the information from the LinkedIn profile, both good and bad, that influenced your beliefs about ...” with the PJ fit exercise asking about “the candidate’s ability to perform the demands of the job well”

and the PO fit exercise asking about “how well the candidate fits with the culture of the organization.” Findings Overall, 32.3% of participants openly reported using FR information to evaluate candidates’ PJ fit, with the amount of FR information they cited ranging from 6% to 100% (M=27.9%, SD=18.4%) of the total information identified. Comparatively, 45.5% of participants openly reported using FR information to evaluate candidates’ PO fit, with the amount of FR information they cited ranging from 6% to 100% (M=40.4%, SD=25.2%) of the total information identified. The amounts of FR information used to evaluate PJ and PO fit were not significantly affected by the sex of the job candidate. However, female participants consistently reported using more FR information to evaluate both PJ and PO fit than their male counterparts – especially when the fast-paced/ competitive organization culture was emphasized. Although participants reported using FR information to evaluate both PJ and PO fit, judgments of the candidates’ well-suitedness for the position were principally related to their use of this information to evaluate PJ fit

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Figure 3: Percentage of Total Information Cited by All Participants Coming from Zones Indicative of Family Responsibilities in Study Conditions: Emphasis on Fast-Paced/Competitive Organizational Culture (low symbolic, high symbolic), Candidate Sex (Susan/Patricia: Female, William/Pedro: Male), Participant Sex (male, female).

(r=-.25, p<.01), with the increased use of FR information to evaluate candidates’ ability to perform job demands having a moderately strong negative relationship with judgments about the candidates’ well-suitedness for the position. This finding demonstrates that employers are willing to openly admit to using FR information to evaluate PJ fit and suggests that the null relationship observed in Study 2 was likely an artifact of the study’s design (i.e., salience of culture misfit).

Overall Conclusions Whereas previous research has demonstrated the effects of FRD on 18

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promotion decisions involving job incumbents with known family responsibilities for traditionally male-gender-typed jobs, this research is the first to demonstrate that external job candidates are less likely to even be considered for a position if their LinkedIn profiles contain information indicative of family responsibilities – especially if they are being evaluated by female employers for jobs at companies with a fast-paced/ competitive (i.e., agentic) organizational culture. Across three studies, approximately one-third of all participants openly reported using FR information to screen job candidates, with 30.1% of the total information they

cited coming from these zones of the LinkedIn profiles on average. Given the popularity of community groups/ interests on LinkedIn pertaining to parenthood, these figures suggest that FRD is likely a widespread issue influencing hiring decisions that are made by employers who use their “expert” judgment to review job candidates’ profiles. Although male employers were expected to use more FR information to evaluate candidates than female employers, the greater use of FR information among female participants may reflect their own personal experiences with jornada dupla, a Brazilian term referring to the “double journey” or “dual difficulty”


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women commonly experience when expected to fulfill both work and primary caregiver responsibilities. For employing organizations, this research demonstrates the need for interventions that serve to prevent FRD through training and/or modifications to personnel selection systems that use LinkedIn to source and screen job candidates. For job seekers, these findings suggest that they not include information that communicates parental responsibilities in their LinkedIn profiles. This, however, would come at the expense of limiting the personalrelational component of social networking.

References Albiston, C., Dickson, K. B., Fishman, C., & Levy, L. F. (2007). Ten lessons for practitioners about family responsibilities discrimination and stereotyping evidence. Hastings Law Journal, 59, 1285-1310. Bureau of Labor Statistics (2018, November). Job openings and labor turnover summary. Retrieved from https://www.bls.gov/news.release/jolts. nr0.htm. Accessed 11/15/18.

Derous, E., Pepermans, R., & Ryan, A. M. (2017). Ethnic discrimination during résumé screening: Interactive effects of applicants’ ethnic salience with job context. Human Relations, 70(7), 860-882. Gasparini, C. (2017, August 31). Este é o segredo para atrair o olhar dos recrutadores no LinkedIn. Retrieved from https://exame.abril.com.br/ carreira/este-e-o-segredo-para-atrairo-olhar-dos-recrutadores-no-linkedin/. Accessed 10/27/17. Guion, R. M. (1998). Some virtues of dissatisfaction in the science and practice of personnel selection. Human Resource Management Review, 8(4), 351-365. Heilman, M. E. (2001). Description and prescription: How gender stereotypes prevent women’s ascent up the organizational ladder. Journal of Social Issues, 57(4), 657-674. Heilman, M. E., & Okimoto, T. G. (2008). Motherhood: A potential source of bias in employment decisions. Journal of Applied Psychology, 93(1), 189.

Karl, K., & Peluchette, J. (2013). Possibilities and pitfalls of using online social networking in human resources management. Psychology for Business Success, 4(1), 119-138. Lauver, K. J., & Kristof-Brown, A. (2001). Distinguishing between employees’ perceptions of person–job and person–organization fit. Journal of Vocational Behavior, 59(3), 454-470. LinkedIn (2018). About LinkedIn. Retrieved from http://press.linkedin. com/about. Perry, E. (1994). A prototype matching approach to understanding the role of applicant gender and age in the evaluation of job applicants. Journal of Applied Social Psychology, 24(16), 1433-1473. Roth, P. L., Bobko, P., Van Iddekinge, C. H., & Thatcher, J. B. (2013). Social media in employee-selectionrelated decisions: A research agenda for uncharted territory. Journal of Management, 20, 1-30. Zide, J., Elman, B., & ShahaniDenning, C. (2014). LinkedIn and recruitment: How profiles differ across occupations. Employee Relations, 36, 583-604.

Kevin P. Nolan is an associate professor of psychology in Hofstra College of Liberal Arts and Sciences, where he teaches courses in the BA in Psychology, MA in Industrial-Organizational Psychology, and PhD in Applied Organizational Psychology programs. He graduated summa cum laude from Wabash College, earned a MS in Industrial-Organizational Psychology from Indiana University – Purdue University Indianapolis, and earned a PhD in Industrial-Organizational Psychology from Bowling Green State University. Nolan’s academic research focuses primarily on employment decision making. His work has been published in a variety of outlets, including the Journal of Applied Psychology, Academy of Management Proceedings, Journal of Business and Psychology, Corporate Reputation Review, Human Performance, Journal of Occupational and Organizational Psychology, Industrial and Organizational Psychology, Consulting Psychology Journal: Practice and Research, Personnel Assessment and Decisions, The Psychologist-Manager Journal, Public Personnel Management, and The Industrial-Organizational Psychologist. As a consultant, Nolan partners with organizations to deliver solutions that bolster engagement, well-being, and effectiveness through the application of best practice principles in the areas of personnel management and organizational development.

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The Janus Project: Future Self and Psychopathology Mark Serper, PhD, Professor of Psychology, Hofstra University This article summarizes some the completed work of the JANUS PROJECT. This is work done in my lab at Hofstra (with former graduate student Yosef Sokol, in particular) as part of our clinical psychology doctoral program. Janus (Figure 1) is the Roman god of beginnings, transitions, time, and duality. As you can see in Figure 1, Janus is depicted as having two faces, since he looks to the future and to the past.

By taking a Janusian perspective to study psychopathology, we are interested in how patients relate their past, present, and future selves in

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their self-identity, and in terms of their intertemporal choices and behaviors. Intertemporal choices are decisions that involve tradeoffs between costs and benefits that occur either in the present or in the future. We take the view that self-identity is not seen as static, but rather consisting of many overlapping selves over time (e.g., Parfit, 1971). These temporal selves can overlap to a greater or lesser degree. Some people, for example, have high levels of overlap between their different temporal selves and, therefore, a sense of personal persistence of identity over time, referred to as diachronicity or self-continuity.

Diachronicity, or continuous identity, is the degree to which a person feels like the same person when comparing their present selves with their past or future selves. Someone with high future self-continuity views their future self as a natural extension of who they are now. In contrast, someone with low future selfcontinuity, or diachronic disunity, feels alienated from their future self and looks upon their future self as a stranger. We and others have found that the amount of future selfcontinuity a person has strongly predicts various mental health difficulties and other concerning behaviors that I will discuss below.


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Future self-continuity can be measured along three overlapping dimensions: proximity to future self; vividness of future self; and temporal self-appraisal (Parfit, 1971; Hershfield et al., 2012; Sokol & Serper, 2017). Vividness of future self has been recognized as an important component of future self-identity. Hershfield (2011), citing Kahneman and Tversky (1973), related their notion that events that are easier to imagine are more vivid in the mind and seem more likely to happen. To measure this dimension of future self, van Gelder et al. (2013) created an immersive virtual reality (IVR) that created realistic age-progressed versions of participants’ future selves in a virtual environment. van Gelder et al. (2013) manipulated vividness of future self by having people with antisocial tendencies either interact with their aged progressed selves in the IVR or participate in a control condition that did not increase vividness of future self. Examining people with antisocial tendencies is interesting because they tend to live in the here and now, and fail to think through the delayed consequences of behavior. Gottfredson and Hirschi (1990) argued that people with a here-and-now orientation tend to respond to tangible stimuli in their

environment and are unable to defer gratification, which leads them to engage in antisocial activity. van Gelder et al. (2013) hypothesized that increasing the vividness of the future self should motivate individuals to act in a more future-oriented way and should therefore reduce delinquent behavior. To measure this, they gave subjects a test wherein they could have the opportunity to cheat. Participants confronted with the IVR older version of themselves were significantly less likely to cheat (6.1%) than were participants in the control condition (23.5%) who did not interact with their IVR. Overall, when vividness of future self was increased, individuals are less inclined to engage in delinquent behavior. Proximity of future self can be measured by how close someone feels to their future self. Below is an adaptation of the Inclusion of Other in the Self Scale (Aron, Aron, & Smollan, 1992) used by Ersner-Hershfield, Garton, Ballard, Samanez-Larkin, and Knutson (2009) to measure self- versus other-connectedness. The Future Self-Continuity Scale uses a series of seven Venn diagrams that overlap to varying degrees, representing the extent to which people feel that their future

Intertemporal choices are decisions that involve tradeoffs between costs and benefits that occur either in the present or in the future.

self is connected to (or similar to) their present self (see Figure 2). Sokol and Serper (2019a) examined future self-continuity using the proximity measure of psychiatry inpatients at a New York metropolitan area hospital. In this study it was found that the psychiatric inpatient group had difficulty perceiving their present and future selves as unified or proximal over time compared to a healthy control group matched for age and gender. Also the lower the patients’ sense of future self-identity, the more severe their expression of their

Figure 2

Current Self

Future Self

Current Self

Current Self

Future Self

Future Self

Current Self

Current Self

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Current Self

Current Self

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future selves, looks surprisingly similar to what happens when participants are asked to think about a stranger (e.g., Kelley et al., 2002; Jenkins et al., 2008). Recent fMRI studies have found that a part of the brain in the rostral anterior cingulate cortex brain region — which usually shows a high level of activity when people think about themselves — quiets down when people with low CI are told to think about themselves 10 years from now. This neural pattern predicted increased temporal discounting assessed a week after the fMRI scanning (Kelley et al., 2002).

psychosis. The inability to consider one’s future is also consistent with the immediacy hypothesis (Salzinger & Serper, 2004), which posits that schizophrenia patients’ temporal focus on the immediate or most proximal stimuli at the expense of consideration of contextual stimuli as well as more distal but relevant stimuli contributes to psychosis. Our findings were consistent with past studies that found patients with various clinical disorders have difficulty imagining specific events that may happen to them in the future (D’Argembeau et al., 2008; Brown et al., 2013). Proximal self-continuity was also highly related to patients’ insight into their psychiatric illness. Awareness of illness is not merely an isolated cognition, but a function of developing a meaningful temporal self-narrative (Kleinman, 1988; Lysaker, Buck & Roe, 2007). Developing a personal narrative of one’s illness requires both autobiographical memory and episodic future thought about potential consequences of illness and the need 22

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for continued treatment compliance to potentially achieve a fuller life. Diachronic disunity was also found to be strongly associated with patients’ negative symptom severity. Negative symptoms include lack of motivation, apathy, flat affect, and social withdrawal. It may be the case that diachronic disunity impairs an individual’s meaningful affective/ interpersonal response to events in the present and projected self in the future. It has been found, for example, that individuals with schizophrenia (SZ) have intact reward sensitivity, but have specific difficulty in considering the consequences and reward value of potential future choices (Serper et al., 2017). Temporal discounting may be conceptualized as a specific type of deficit in future episodic thinking that may drive apathy and motivational deficits and difficulties in making choices for future life decisions. Along these lines, brain activity in people with low continuous identity (CI), when asked to think about their

The last component of continuous identity is temporal self-appraisal. Temporal self-appraisal examines how a person views themselves over time (past, present, and future). Euthymic individuals (people with a healthy, productive mood state) typically maintain a positive view of their current self by denigrating their past selves. Euthymic individuals believe that their lives follow a continuously improving trajectory where evaluation of their pastself includes more self-criticism than their evaluation of their present-self, and that their future-self is evaluated even more positively than their present-self. This is called “self-enhancement bias” (Wilson & Ross, 2001). In a recent study (Sokol & Serper, 2017), we asked the question, Is there a self-enhancement bias for people suffering from depression? Some past studies have suggested that people with depression: 1. I ncrease rumination about an idealized version of a past-self. 2. H old a more negative view of their current self.


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3. Have an even greater negative view of their future self (due to their hopelessness about the future). This would be an opposite pattern to the self-enhancement bias routinely found in healthy individuals. To answer this question, we compared 75 people who scored very high on a measure of depression severity to 144 individuals who endorsed very few items on the same scale, indicating they are not experiencing symptoms of depression. To measure temporal self-appraisal, we used the Me/Not Me task developed by Hershfield and colleagues (2012). In this task, subjects are presented with 10 positive words and 10 negative words and then asked to rate their present, past, and future selves for each word along a 6-point Likert scale anchored with “1” meaning the word did not describe them at all, “3” meaning the word is somewhat descriptive, and “6” meaning the word perfectly described them for their past, present, and future self (scores can range from -6 to +6). We were interested in finding out how the depressed group performed on the temporal self-appraisal, rating their past, present, and future selves using these positively and negatively valanced attributes to describe their various selves. We hypothesized that the depressed group would characterize their future self as more negative than their present or past self in a pattern that would be the opposite of a selfenhancement bias. What we found, however, was surprising and the opposite of what we expected (summarized in Figure 3). We see the healthy controls (blue line) displayed the Ross and Wilson self-enhancement bias. The depressed group, however, did not show the self-enhancement bias. Instead, depressed subjects’ past and future

selves were at similar levels, and both were significantly higher than the subjects’ perception of their present self-worth. These results suggested that depressed individuals derogate their current self but idealize or elevate the attributes of both their past self and future self. This finding was very interesting because the literature suggests that depressed individuals are pessimistic and hopeless about their future (Beck, 1967). We found that this is not the case with regard to the future self. Next we were interested in asking if this was a fluke finding. To find out, we replicated this study using a new sample of people (Study 2). But in Study 2, we also added a measure of clinical hopelessness to see how it compared to patients’ future selfcontinuity measure of temporal self-appraisal. Again, we created two groups of subjects but in addition to dividing patients into depressed and nondepressed groups, we selected nondepressed subjects who scored very low on the hopelessness scale and used only depressed subjects who also scored high on our measure of hopelessness about the future. In this way we could try to separate depressed individuals’ hopeless attributions about the future from their temporal appraisal of their future self. Our groups in this study included: 1. Nondepressed and non-hopeless individuals (n =168) 2. Depressed and hopeless individuals (n = 63) Study 2 results replicated Study 1 findings that nondepressed individuals have a self-enhancement bias, perceiving themselves as increasing in positive personal traits from the past to the present, and again, from the present to the future. So while nondepressed individuals see themselves as having

Reinforcing strategies that help patients imagine a future self that is vivid, proximal, and continuous to their current self may help guide individuals to engage in cross-temporal behaviors that benefit their future self, which in turn may promote better current and future functioning.

continuous identity over time, they also see themselves as significantly improving in the future in terms of perceived self-attributes. In addition, we found in both Study 1 and Study 2 that the depressed mood group presented with a nonlinear pattern of temporal self-appraisal, deteriorating from their past to their present self, and improving (or recovering) from the present to the future self, back to a similar level they appraised their past self (Sokol & Serper, 2017). The findings (summarized in Figure 4) revealed that we replicated the results of the first study. These results are consistent with past findings suggesting that euthymic individuals are more likely to see themselves as having a stable and continuous self-identity over time, while a discontinuous identity over time Hofstra HORIZONS t Spring 2020

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their current self may help guide individuals to engage in cross-temporal behaviors (e.g., participating in psychotherapy; investing in education or vocational training) that benefit their future self, which in turn may promote better current and future functioning.

References Aron, A., Aron, E. N., & Smollan, D. (1992). Inclusion of other in the self scale and the structure of interpersonal closeness. Journal of Personality and Social Psychology, 63, 596–612.

(diachronic disunity) is associated with increased depression severity and suicidality (Sokol & Serper, 2016). While depressed and hopeless individuals had lower opinions of their self at all three time points than the euthymic group, they did not project a trajectory of deteriorating self-appraisal into the future even though they rated themselves as depressed and hopeless about their future. Our results suggest that while depressed individuals trend toward hopeless and pessimistic outlooks concerning their future life prospects, they also concomitantly trend toward a more optimistic sense of their future selves. The pattern of findings supports the notion that depressed individuals see themselves as having a “recovery” trajectory where they will improve in the future, or return to the level of positive attributes that defined their past self. These findings are consistent with Viktor Frankl’s (1959) notion of perceived self-enhancement through suffering and in line with research indicating many individuals demonstrate

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posttraumatic growth where they respond to current negative life events with perceived profound internal growth in areas such as interpersonal relationships and personal strength (Tedeschi & Calhoun, 2004; Calhoun & Tedeschi, 2014). So, like the god Janus, human beings, whether depressed and hopeless, suffering from psychosis or not, look to their past self but also may get inspiration to self-enhance by looking to their future self. One goal for treatment may be to foster a sense of unity between present and future selves and examine how current life decisions may affect a future self. In past reports, it has been found that we can increase people’s ability to take both past and future self into broader consideration (Bartles & Rips, 2010; Sadeh & Karniol, 2012; Sokol & Serper, 2019b). Our results, however, set the stage for longitudinal and treatment studies aimed at unifying temporal dimensions of the self. Reinforcing strategies that help patients imagine a future self that is vivid, proximal, and continuous to

Bartels, D., & Rips, L. (2010). Psychological connectedness and intertemporal choice. Journal of Experimental Psychology: General, 139, 49-69. Beck, A. T. (1967). Depression: Clinical, Experimental, and Theoretical Aspects. University of Pennsylvania Press. Brown, A. D., Root, J. C., Romano, T. A., Chang, L. J., Bryant, R. A., & Hirst, W. (2013). Overgeneralized autobiographical memory and future thinking in combat veterans with posttraumatic stress disorder. Journal of Behavior Therapy and Experimental Psychiatry, 44, 129-134. Calhoun, L. G., & Tedeschi, R. G. (2014). Handbook of Posttraumatic Growth: Research and Practice. Routledge. D’Argembeau, A., Raffard, S., & Van der Linden, M. (2008). Remembering the past and imagining the future in schizophrenia. Journal of Abnormal Psychology, 117, 247-251. Ersner-Hershfield, H., Garton, M. T., Ballard, K., Samanez-Larkin, G. R., & Knutson, B. (2009). Don’t stop thinking about tomorrow: Individual differences


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in future self-continuity account for saving. Judgment and Decision Making, 4, 280-286.

self? An event-related fMRI study. Journal of Cognitive Neuroscience, 14, 785-791.

Care Companion for CNS Disorders, 18. https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC4874761/

Frankl, V. E. (1959). Man’s Search for Meaning. Simon and Schuster. New York, NY.

Kleinman, A. (1988). The Illness Narrative. Suffering, Healing and the Human Conkdition. Basic Books. New York, NY.

Sokol, Y., & Serper, M. (2017). Temporal self-appraisal and continuous identity: Associations with depression and hopelessness. Journal of Affective Disorders, 208, 503-511.

Gottfredson, M. R., & Hirschi, T. (1990). A General Theory of Crime. Stanford University Press. Stanford, Ca. Hershfield, H. E. (2011). Future self-continuity: How conceptions of the future-self transform intertemporal choice. Annals of the New York Academy of Science, 1235, 30-43. Hershfield, H. E., Cohen, T. R., & Thompson, L. (2012). Short horizons and tempting situations: Lack of continuity to our future selves leads to unethical decision making and behavior. Organizational Behavior and Human Decision Process, 117, 298-310. Jenkins, A. C., Macrae, C. N., & Mitchell, J. P. (2008). Repetition suppression of ventromedial prefrontal activity during judgments of self and others. Proceeds of the National Academy of Sciences, 105, 4507-4512. Kahneman, D., & Tversky, A. (1973). On the psychology of prediction. Psychological Review, 80, 237-251. Kelley, W. M., Macrae, C. N., Wyland, C. L., Caglar, S., Inati, S., & Heatherton, T. F. (2002). Finding the

Lysaker, P. H., Buck, K. D., & Roe, D. (2007). Psychotherapy and recovery in schizophrenia: A proposal of key elements for an integrative psychotherapy attuned to narrative in schizophrenia. Psychological Services, 4, 28-37. Parfit, D. (1971). Personal identity. Philosophical Review, 80, 3-27. Sadeh, N., & Karniol, R. (2012). The sense of self-continuity as a resource in adaptive coping with job loss. Journal of Vocational Behavior, 80, 93-99. Salzinger, K., & Serper, M. (2004). The immediacy mechanism. International Journal of Psychological Therapy, 4, 1-13. Serper, M., Payne, E., Dill, C., Portillo, C., & Taliercio, J. (2017). Allocating effort and anticipating pleasure in schizophrenia: Relationship with real world functioning. European Psychiatry, 46, 57-64. Sokol, Y., & Serper, M. (2016). The relationship between continuous identity disturbances, negative mood, and suicidal ideation. The Primary

Sokol, Y., & Serper, M. R. (2019a). Temporal self, psychopathology, and adaptive functioning deficits: An examination of acute psychiatric patients. The Journal of Nervous and Mental Disease, 207, 76-83. Sokol, Y., & Serper, M. (2019b). Experimentally increasing selfcontinuity improves subjective wellbeing and protects against self-esteem deterioration from an ego-deflating task. Identity, 1, 157-172. Tedeschi, R. G., & Calhoun, L. G., (2004). Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15, 1-18. van Gelder, J. L., Hershfield, H. E., & Nordgren, L. F. (2013). Vividness of the future self predicts delinquency. Psychological Science, 24, 974-980. Wilson, A. E., & Ross, M. (2001). From chump to champ: People’s appraisals of their earlier and present selves. Journal of Personality and Social Psychology, 80, 572-584.

Mark Serper holds a doctorate in clinical psychology from the State University of New York at Binghamton. He completed a clinical internship and fellowship in neuropsychology at Mount Sinai Medical School in New York City. He is currently a full professor in Hofstra University’s PhD in Clinical Psychology program as well as an adjunct professor at the Icahn School of Medicine at Mount Sinai. He teaches both graduate and undergraduate courses at Hofstra. Prior to joining the Hofstra faculty, he worked in the NYU/Bellevue Hospital Psychiatric Emergency Services. In addition to self-continuity research, Serper is interested in attention and memory dysfunctions in schizophrenia and bipolar illness, aggression and psychosis, and recovery-oriented approaches for severe and persistent mental illnesses. He has published over 100 articles and book chapters and has received grants from NIMH and the Brain & Behavior Research Foundation, formerly known as the National Alliance for Research on Schizophrenia and Depression (NARSAD).

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A Look Toward the Future of Treating Psychiatric Disorders Keith Shafritz, PhD, Professor of Psychology, Hofstra University A great challenge for the fields of psychiatry and clinical psychology is establishing an accurate diagnosis, followed by the initiation of a treatment program that is successful for each individual client or patient. For

many patients, however, determining the appropriate diagnosis is fraught with difficulty, and initial attempts at treatment are sometimes ineffective. For example, approximately one-third of patients with schizophrenia or related psychotic disorders do not see symptom improvement even after trying two different medication treatments. Furthermore, symptoms of many disorders overlap, often 26

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making it exceedingly difficult to differentiate one potential diagnosis from another. For example, ritualistic and repetitive behaviors are core symptoms of both obsessive-compulsive disorder (OCD) and autism spectrum disorder (ASD), and engaging in these behaviors can impair social interactions. However, whether a clinician determines that such behaviors are due to OCD or ASD will have implications for treatment and services offered to the families. Similarly, inattention and impulsivity can result from several different conditions, including attention-deficit/hyperactivity

disorder (ADHD) and anxiety. However, recommended treatments for these two disorders could not be more different from one another. For medication management of ADHD, the person may be prescribed a low dose of a stimulant drug, such as amphetamine, while for anxiety, the person may be prescribed a drug such as Prozac or Zoloft. Behavioral-based treatments for ADHD and anxiety also differ dramatically. Currently, diagnosis of mental illness is established through careful observation by clinicians and the reporting of symptoms during a clinical interview, often


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accompanied by symptom checklists completed by patients or caregivers. To aid in this process, two classification systems have emerged: the Diagnostic and Statistical Manual for Mental Disorders, published by the American Psychiatric Association and currently in its fifth edition (DSM-5), and the International Classification of Diseases, published by the World Health Organization and currently in its 10th edition (ICD-10). These books provide a way for clinicians and researchers to classify different disorders based upon the presenting symptoms. However, they do not indicate how to treat the different disorders, nor do they provide specific guidelines as to how to measure the various symptoms. Rather, the books provide a series of criteria for each disorder, and then clinicians and researchers create questionnaires and clinical observation systems that are used to assess for the presence or absence of symptoms and to establish the severity of those symptoms within each individual. A common theme emerging from such a method for establishing diagnosis is that differentiating one diagnosis from another can be highly subjective. Two (or more) clinicians can observe the same person and establish two (or more) different diagnoses. It is difficult to determine which of these diagnoses is correct, or whether the person truly has more than one condition. Therefore, the National Institutes of Health has recently established a research priority to create a different way of classifying and diagnosing mental illness. This program, known as the Research Domain Criteria (RDoC), attempts to combine genetics, neuroscience, and behavior, in an effort to better classify and understand mental illnesses

(Insel et al., 2010). By combining aspects of a person’s biology with their thoughts and behaviors, it may be possible to tailor specific treatment programs to specific patients and improve the overall success of treatments for mental illness. Consistent with this approach, my research program uses a combination of brain imaging and behavioral testing to better understand the underlying brain basis for mental disorders and their associated treatments. For the past several years, I have focused my efforts on two clusters of disorders, ASD and psychosis spectrum disorders, which includes schizophrenia and related conditions. ASD is a neurodevelopmental disorder characterized by impairments in social interactions and/or social communication, and the presence of repetitive, stereotyped behaviors or a

Diagnosis of mental illness is established through careful observation by clinicians and the reporting of symptoms during a clinical interview ...

restricted (i.e., limited) set of interests. The number of cases of ASD diagnosed in the past decade has skyrocketed, primarily due to a broadening of diagnostic criteria, along with better awareness of the disorder. Schizophrenia and the related psychosis spectrum are characterized by the presence of hallucinations, which are

Figure 1: Examples of individual task trials from the Emotional Face Go/No-Go task. Part (A) on the top shows the first few images from a group of trials of the Go condition, while Part (B) on the bottom shows the first few images from a group of trials of the fear No-Go condition. The times listed under each screen are the presentation times in milliseconds (ms).

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A major advance in the fields of psychology, neuroscience, and psychiatry is the ability to noninvasively track activity throughout the entire brain while a person completes one or more behavioral tasks.

visual or auditory perceptions that are not there in reality, and delusions, which are thoughts that are unrealistic, such as believing you are the leader of a country, you are being pursued, or your thoughts are being controlled by outside forces. Schizophrenia is also marked by “cognitive” symptoms, including impairments in working (i.e., “shortterm”) memory, planning, and inhibiting impulsive responses. Common to both ASD and schizophrenia is a deficit in executive functioning, which refers to a collection of mental processes that allows for flexible, adaptive behaviors. These executive functions include planning, inhibiting inappropriate or ongoing responses, generating the most fitting response, monitoring performance, making appropriate adjustments when errors occur, and allocating attentional resources where needed. Collectively, these mental processes allow us to alter our behavior according to current needs or the social rules and conventions that govern behavior. Therefore, executive functions have also been referred to as our cognitive control mechanism. 28

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A rather substantial number of behavioral tests exist to examine executive functioning, some testing one specific aspect of executive function and others testing multiple components. One of the most common tests to examine response inhibition is the Go/ No-Go task, in which participants are instructed to press a response button (on a keyboard or response box) for each stimulus they see appearing on a computer screen. However, when they see a predesignated target stimulus, the person must withhold their ongoing response. In a common variant of this task, English letters are presented one at a time and participants are instructed to press a button for all letters except the letter X. Other versions of the test use more complex stimuli, such as emotionally expressive faces. In the Emotional Face Go/No-Go, participants are instructed to press the response button for all faces except for those depicting a specified emotion – happiness, for example. These more complex versions of the Go/No-Go task allow us to examine decision-making in social or emotional contexts. Another common test of response inhibition requires decisions that are inconsistent with a standard (or “prepotent”) way of thinking or behaving, which measures a construct known as “response conflict.” In one version of this test, a geometric shape is presented either on the left- or right-hand side of a computer screen. Participants are given a response box with two buttons, one on the left and one on the right. They are instructed to either press the response button that matches the side on which the shape is presented or that is on the opposite side of the shape. For the “opposite side” task, participants must overcome the prepotent tendency to press the button corresponding to the same side as the shape.

A major advance in the fields of psychology, neuroscience, and psychiatry is the ability to noninvasively track activity throughout the entire brain while a person completes one or more behavioral tasks. Using strong magnetic fields, functional magnetic resonance imaging (fMRI) is a technology that detects subtle changes in blood flow to regions of the brain that are used during a mental activity. By comparing the amount of blood flow during one mental activity with that during an alternate activity, we can determine which areas of the brain are used more for that specified mental activity. What makes fMRI particularly attractive as a research tool, compared with alternative methods for examining brain function such as positron emission tomography, is that fMRI poses very little danger to participants and involves no radiation exposure. Therefore, fMRI is wellsuited for use in children and adults, and people can be scanned repeatedly without adverse side effects. Using a type of MRI scanning called diffusion tensor imaging (DTI), MRI technology also allows researchers to examine the integrity of axon pathways, which are the connections between brain regions that communicate messages from one region to another. These axon pathways, also known as the brain’s white matter, have been referred to as the information superhighway of the brain. By examining the integrity of these pathways, we can infer how well specific brain regions are communicating with one another. Recent studies in my lab have utilized these two aspects of MRI technology to determine underlying brain differences in adolescents with autism when compared with adolescents without a psychiatric diagnosis, often referred to as “neurotypical” adolescents. In one


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Figure 2: Brain activations during the Emotional Go/No-Go task. Areas in yellow and orange show regions with increases in brain activity. Brain region labels refer to the areas of activity appearing just below the labels. Adapted from Shafritz et al. (2015).

Figure 3: Brain activations during the Response Conflict task that correlated with amount of symptom reduction after 12 weeks of antipsychotic medication treatment in patients experiencing their first episode of psychosis. Adapted from Shafritz et al. (2018).

study, my colleagues and I used fMRI to determine whether the brain regions normally active when people make quick decisions about whether or not to respond to emotionally expressive faces are also recruited in adolescents with ASD (Shafritz et al., 2015). Participants completed an emotional face Go/No-Go task with happy, fearful, and neutral faces while being scanned in an MRI machine. While in the scanner, the participants saw emotionally expressive faces presented one at a time on a computer screen that they were able to view by looking at a prismatic mirror placed above their heads. The task was divided into Go and No-Go conditions. During the Go conditions, participants were instructed to press a response

button for all faces they saw. During the No-Go conditions, faces of two differing emotions were presented, and participants were instructed, “Do not press for happy faces,” or “Do not press for fearful faces,” in alternating sets of task trials (see Figure 1). We found brain activity differences between the ASD group and the neurotypical group that provide empirical support for an important theory of ASD suggesting that the disorder is marked by a deficit in social motivation (i.e., the inherent desire to engage in social interactions). Specifically, we found that the nucleus accumbens, a region found deep within the brain and long-known to be involved

in reward, became active when neurotypical individuals viewed happy faces, but not when individuals with ASD viewed happy faces. Instead, participants with autism recruited brain regions that are implicated in the basic perceptual processes involved in facial recognition, such as the fusiform gyrus, indicating that people with autism may need to use basic perceptual brain regions to a greater extent than neurotypicals when interpreting facial expression (see Figure 2). Because the participants with autism did not recruit the nucleus accumbens, they may have experienced less pleasure compared with neurotypicals when viewing happy faces, which would be consistent with the social motivation theory.

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Our results suggest that if we target therapeutic strategies to the functioning and integrity of these midline brain structures, perhaps we can improve the impairments in executive functioning that are currently quite difficult to treat in people with ASD.

In a companion study, my colleagues and I used DTI to examine the integrity and development of axon pathways in individuals with autism (Ikuta et al., 2014). During DTI scanning, participants do not need to engage in a mental activity; rather, they simply lay still in the MRI machine while the machine detects the speed and direction of water molecules moving through the axons in the brain. The movement of these water molecules allows us to determine the integrity of the axon bundles connecting various brain regions. In typical development, the integrity of the axon pathways increases throughout adolescence as the connections between specific brain regions become more established and efficient. We found that in individuals with autism, one of these axon bundles, known as the cingulum bundle, does not exhibit this typical pattern of increased connectivity and efficiency. This pathway runs along the midline of the brain, connecting areas of the frontal

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lobes to the parietal and temporal lobes that lie behind and below the frontal lobes. Because it connects the front and back of our brains, the cingulum bundle is thought to assist in integrating our perceptions with our actions, which is an important aspect of executive functioning. The participants in our study also completed a questionnaire, known as the Behavior Rating Inventory of Executive Function (BRIEF), which assesses two distinct domains of executive functioning: behavior regulation and meta-cognition (the ability to assess the contents of your own thoughts). We examined the relationship between scores on this measure with the integrity of the cingulum bundle on a subject-by-subject basis. We found that the integrity of the cingulum bundle was related to executive functioning ability; as the integrity of the cingulum bundle increased, behavior regulation abilities improved. Combined with prior research results showing a relationship between cingulate function, executive functioning, and repetitive behaviors in autism (Shafritz et al., 2008), these results reveal the importance of midline brain structures to the core symptoms of ASD. Our results suggest that if we target therapeutic strategies to the functioning and integrity of these midline brain structures, perhaps we can improve the impairments in executive functioning that are currently quite difficult to treat in people with ASD. In another line of research using fMRI, my colleagues and I examined patterns of brain activity in patients with schizophrenia spectrum disorder who were experiencing their first psychotic episode. We aimed to find brain regions for which the amount of activity during an attention task would distinguish patients whose symptoms would

improve by taking antipsychotic medication from patients whose symptoms would not improve (Shafritz et al., 2018). Patients for this study were recruited as part of an ongoing randomized controlled trial taking place at Zucker Hillside Hospital in which patients were assigned to regularly take one of two antipsychotic medications: risperidone (Risperdal) or aripiprazole (Abilify). At the start of their medication treatment, patients were scanned using fMRI while they completed the “response conflict” task described above. We then used their brain activation patterns before treatment to predict their therapeutic response to the antipsychotic medication 12 weeks into treatment. We also compared their brain activation during the task with that of a control group. We observed that activation in a midline brain region in the frontal lobes, called the anterior cingulate cortex, differed between the control group and the first-episode psychosis patients while they completed the response conflict task. We also found that activation in the anterior cingulate cortex and two additional areas of the brain was strongly associated with the patients’ response to the medication in terms of their symptomatic and functional improvement (see Figure 3). Combined with other recent findings that whitematter integrity can also predict antipsychotic treatment success (Sarpal et al., 2016), our finding can be used to create a standardized brain scanning procedure that in the future may become part of routine care in the treatment of psychosis. This type of screening procedure has the potential to advance the goals of personalized medicine by eliminating the guesswork involved in prescribing medication. Continuing with research designed to create new ways of predicting functional outcomes in psychiatric disorders, my


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colleagues and I are currently using fMRI to investigate patterns of brain activation in U.S. armed forces veterans who are experiencing symptoms of post-traumatic stress disorder. We are conducting this series of research studies at the James J. Peters VA Medical Center in Bronx, NY, in collaboration with research teams at the VA New Jersey Health Care System and Rutgers University. Veterans with and without traumatic brain injury, and with and without a history of suicide attempts, are being scanned using fMRI while they complete decision-making tasks, including the Go/No-Go task. We expect to find that impulsive responding during these mental activities will be associated with specific patterns of brain activation that are also associated with a history of suicide attempts. We will then use the observed patterns of brain activation to predict whether patients are at a high risk for suicide attempts. The goal of these research studies will be to create a brain scanning procedure that can assist with determining risk for suicide, so that patients at highest risk will be offered

the most intensive therapeutic services available. Because suicide among veterans is highly prevalent, addressing this crisis will hopefully lead to suicide prevention among veterans and in the general population.

Acknowledgments The research described here has been funded by grants from the National Institute of Mental Health and the United States Department of Veterans Affairs. Thanks to Dr. Donna Lutz for helpful comments. References Ikuta, T., Shafritz, K. M., Bregman, J., Peters, B., Gruner, P., Malhotra, A. K., & Szeszko, P. R. (2014). Abnormal cingulum bundle development in autism: A probabilistic tractography study. Psychiatry Research: Neuroimaging, 221, 63-68. Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., et al. (2010). Research domain criteria (RDoC): Toward a new classification framework for research on mental disorders. The American Journal of Psychiatry, 167, 748-751.

Sarpal, D. K., Argyelan, M., Robinson, D. G., Szeszko, P. R., Karlsgodt, K. H., John, M., et al. (2016). Baseline striatal functional connectivity as a predictor of response to antipsychotic drug treatment. The American Journal of Psychiatry, 173, 69-77. Shafritz, K. M., Bregman, J. D., Ikuta, T., & Szeszko, P.R. (2015). Neural systems mediating decision-making and response inhibition for social and nonsocial stimuli in autism. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 60, 112-120. Shafritz, K. M., Dichter, G. S., Baranek, G., & Belger, A. (2008). The neural circuitry mediating executive functioning deficits in autism. Biological Psychiatry, 63, 974-980. Shafritz, K. M., Ikuta, T., Greene, A., Robinson, D. G., Gallego, J., Lencz, T., DeRossse, P., Kingsley, P. B., & Szeszko, P.R. (2018). Frontal lobe functioning during a simple response conflict task in first-episode psychosis and its relationship to treatment response. Brain Imaging and Behavior, 13, 541-553.

Keith Shafritz is professor in the Department of Psychology at Hofstra University, as well as professor in the Center for Psychiatric Neuroscience at the Feinstein Institutes for Medical Research, a division of Northwell Health. He is the author of peer-reviewed research articles in high-profile scientific and medical journals, and an invited chapter on hyperactivity in the Cambridge Handbook of Psychology, Health, and Medicine, Third Edition. His research interests focus on the brain basis of psychiatric disorders, including autism spectrum disorder, attention-deficit/hyperactivity disorder, schizophrenia spectrum disorders, and post-traumatic stress disorder. His current research uses brain imaging techniques to study the effects of trauma in U.S. veterans. Shafritz earned a BA in Psychology from Haverford College and a PhD in Neuroscience from Yale University. Prior to joining the Hofstra faculty in 2006, he served as postdoctoral research associate in psychiatry at Yale University and at the Brain Imaging and Analysis Center at Duke University. He also served as a visiting assistant professor at Drew University. As a faculty member at Hofstra, Shafritz has taught a variety of courses in psychology and neuroscience, such as Clinical Neuropsychology, Behavioral Neuroscience, Research Seminar in Neuroscience, Research Seminar in Clinical Psychology, Introduction to Neuroscience, and Statistics. He also served as chairperson of the Department of Psychology from 2013 to 2016.

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The Effects of a Home-Based Intervention Conducted by College Students for Young Children With Developmental Delays in Vietnam Jin Y. Shin, PhD, Associate Professor of Psychology, Hofstra University Intellectual developmental disabilities often create severe emotional and financial impacts on individuals and families, who may have to provide lifelong support. In addition, affected individuals and their families suffer from social isolation and stigma attached to disability due to traditional, religious, or social attributions for disability that exist in their indigenous cultures. In many Western and/or industrialized countries, it has been recognized that interventions delivered early in the lives of such children bring developmental gains and improve daily and social functioning (Ramey 32

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et al., 2007). Many of these countries mandate or make intervention services available to the affected infants and young children as soon as they are identified as disabled or at risk of developmental delay (Odom, 2003). Moreover, early intervention services typically address the needs of the family as well as those of the child, with much of the evidence suggesting that such intervention is beneficial to these children and their families (Ramey et al., 2007). In addition, highquality, intensive educational efforts that begin early in life tend to lead to the greatest developmental gains (Ramey et al., 2007).

There is little research that documents the effects of early intervention in low- and middleincome countries (LMICs, Emerson et al., 2012). There are many children from LMICs whose medical conditions or developmental delays/disabilities would qualify them for early intervention services in the United States and other developed countries but who do not obtain such services because they are not identified early enough or because no such services are available in the community. In developed countries, such children typically receive intervention services that are multidisciplinary or


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interdisciplinary, with professionals from different disciplines coordinating their work. However, the institutions and teams of highly specialized professionals are not usually available in LMICs, which are short of professionals in every area of human service (Einfeld et al., 2012).

Early Intervention in Vietnam Vietnam has a population of 97 million (CIA, 2019). One of the fastestemerging economies in Asia, Vietnam is still a relatively poor country with a GDP of US $6,900 per capita (CIA, 2019). It is estimated that approximately 2.79% of children aged 2-17 have a disability (General Statistics Office, 2018). In Vietnam, the Law on Education legally entitles people with disabilities to equal educational rights (Rosenthal, 2009). Integrated education has been the focus of Vietnamese policy on special education. Since the inclusive education model has been implemented, the number of children with disabilities attending schools appears to have been rising steadily (Le, 2013). However, the main barrier to special education in Vietnam is teacher training (Rosenthal, 2009; General Statitstics Office, 2018); there are few special education teacher training programs established in Vietnam. Although training for teaching children with disabilities is included in the national teacher training curriculum and there has been an increase in the number and skill level of special education teachers, educational programs and classroom conditions do not meet the demand for special education. Traditionally, Vietnamese children with disabilities have been cared for by their families, who often have viewed the children as burdens to society or objects of shame and pity (Hunt, 2005). Parents of children with disabilities in Vietnam report higher

levels of stress and poorer health compared to those with normally developing children due to lack of social support, which is also related to lack of professional support and stigma-related lack of social interaction (Shin & Nhan, 2009).

Purpose of the Study The purpose of the project was to assess the efficacy of a home-based intervention program for children between the ages of 3 and 6 years with developmental delays in Vietnam. The intervention was designed to provide treatment by trained student teachers to meet the needs of individual children and families in the natural setting of the home. These children and their families received weekly services at their homes for six months by trained college student teachers. The intervention services consisted of implementing weekly teaching goals with children and their parents by working directly with children and modeling teaching techniques for their parents. The children included in the study had never received intervention services before but needed remedial services due to their significant lack of developmental progress in kindergarten programs, which serve children ranging from 2 to 6 years of age before they move on to elementary schools.

Parents of children with disabilities in Vietnam report higher levels of stress and poorer health compared to those with normally developing children due to lack of social support, which is also related to lack of professional support ...

We used the Portage curriculum (CESA 5, 2003), based on the successful implementation of the intervention program with the same aged children conducted in Vietnam from 2005 to 2007 (Shin et al., 2009). The assessment of the program efficacy was carried out by comparing children who received services for six Hofstra HORIZONS t Spring 2020

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The results of the project reveal that the strategies we have adopted to implement the intervention program for children with developmental delays in Vietnam are promising.

months and those who did not. We used the 2005 Vineland Adaptive Behavior Scales-II (Vineland Scale; Sparrow et al., 2005) as an indicator of adaptive behavior and developmental competence. It was hypothesized that the children in the intervention group would show greater progress in adaptive behavior than the children in the control group.

Methods Participants Hanoi is the capital city of Vietnam and is made up of 10 districts. We contacted 30 kindergarten programs in seven of these districts. The kindergarten programs in Vietnam run from 9 a.m. to 5 p.m. every day and serve children from 2 to 6 years of age. Sixteen kindergarten programs participated in the project. Teachers of the kindergarten programs were asked to identify children as having intellectual delays, and their delays were confirmed by trained evaluators who administered the Vineland Scale. Eighty children who met the study criteria participated in the intervention program. After matching by gender and age, these children were randomly assigned to the intervention and control groups. The children in the control group received the intervention services after six months. Regardless of their participation status in the intervention, all children were enrolled in kindergarten programs.

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Procedures and Measures Twenty student teachers were recruited from the Department of Psychology and Pedagogy of Hanoi National University of Education. We asked the students in upper class levels to participate in the project if they were interested in working with young children with developmental delays. Although they were interested in working with these children, none of the students had prior knowledge of or experience working with this population. Before they began the program, they received three months of weekly training conducted by Dr. Son Duc Nguyen, who was the lead investigator in Vietnam and a psychologist. An experienced clinical supervisor provided necessary training and clinical supervision of the teachers throughout the project period by attending the supervision meetings or by being available to speak with them by phone or to meet with them individually. Each teacher was assigned to work in the homes of two children and provided the weekly home-visit services for six months. Each home-visit session lasted about an hour. The teachers used the Portage curriculum manual to develop teaching objectives and activities based on the needs and issues the parents raised about their children. Twenty student evaluators were recruited separately from the department, trained to administer the Vineland Scale, and evaluated the children at 0, 3, and 6 months. The Vineland Scale (Sparrow et al., 2005) was used to assess the children’s development over the six-month intervention period. The scale provides a measure of adaptive behavior obtained through interviews with the parents. The scale generates the adaptive behavior composite, which is an overall adaptive behavior score. It


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intervention group gaining significantly more than the control group over time in these areas.

Discussion The results of the project reveal that the strategies we have adopted to implement the intervention program for children with developmental delays in Vietnam are promising. The intervention group

consists of subdomains in the areas of communication, socialization, motor skills, and daily living.

months in the areas of communication, social skills, and motor skills.

Results We compared the adaptive behavior composite scores as well as the subdomain scores for the intervention and control groups at three time points. A repeated measures ANOVA was performed to examine the difference between the groups in terms of their improvement on the adaptive behavior composite (the overall adaptive behavior score) at three and six months. There was a significant group x time effect over the course of six months, indicating that the intervention group improved significantly more than the control group in overall adaptive functioning (see Figure 1).

Another set of repeated measures ANOVAs was computed to examine differences between the two groups of children in 11 subdomains of the scale at three different time points during the intervention. Although the overall score of the communication domain showed a significant interaction effect, there were no interaction effects between group and time detected for the subdomains of communication, such as expressive, receptive, and writing skills domains. Among the subdomains of social skills, the areas of play and leisure time showed a significant group and time interaction, revealing that the intervention group did better than the control group over the course of six months. Among the subdomains of motor skills, the interaction between time and group was significant for both gross and fine motor skills, with the

Repeated measures ANOVAs were computed to examine group differences on four domains of the scale (communication, social skills, daily living skills, and motor skills). There were significant group x time effects over the course of six months for all domains except in the area of daily living skills. The intervention group made significant gains over six

from the current project made significantly greater gains than the control group in overall adaptive behavior and in the areas of communication, socialization, and motor skills. The children in the intervention group improved in all areas except daily living skills compared to the control group. Many of the children who participated in the study were repeating their grades at the kindergarten level and had not

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format. Many children could not wait for their “big brother” or “big sister” to show up at their house gate and to start their play session together.

been able to move on to elementary school. For this reason, the parents were most anxious to see an improvement in their children’s study skills, which might be reflected in the improvement in the area of communication skills. Although the overall improvement in communication skills was significant, the gains in the specific areas of writing, reading, and comprehension skills were not significant, revealing the challenges that the children and their families still face in improving their academically related skills. The children in the intervention group made significant improvements in socialization skills. While these children were excluded from social play by their peers, the fact that the teachers came to their home to work and play with them regularly appeared to play a major role in improving their social skills in the area of play. The teachers designed their session to be interactive and brought many materials to engage the children in a playful

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There was no improvement in daily living skills; probably, the parents did not expect children in this age group to clean their rooms and to dress themselves. Regarding the motor skills, the teachers actively engaged the children in physical activities, such as playing with balls and physical exercises, along with exercises in fine motor skills, such as drawing. This might have helped to improve the motor skills of the children. In the LMIC context, having a curriculum manual written in clear and simple language can be effective when teachers do not have a background in special education or much access to ongoing education, training, and supervision. A curriculum that offers strategies of behavior modification and ample examples of educational activities helped the teachers generate ideas and plans for their education program. Although the teachers were not experienced, with motivation, commitment, and close supervision, they could educate children with moderately and mildly delayed levels of intellectual capacity. Another effective strategy in LMIC contexts could be the identification of educational institutions in settings where students could be recruited and

trained as potential interventionists/ special education specialists. Those who are motivated and interested in working with such children can be effectively trained with ongoing supervision and feedback. The project was also a success in that the student teachers enjoyed working with the children and families, obtaining substantial experience and skills training throughout the program, with some inspired to pursue a career in special education. The parents also recognized the benefit of the intervention, with some hiring the student teachers to continue to work with their children after the intervention was over. Our observations, experiences, and data from our time in Vietnam all indicate that an early intervention program for children with developmental delays and their families may be implementable in low-income nations where resources are sparse. The improvements that we report here were all achieved through a limited level of teacher skills and manualized treatments that are easy to use. While the program may not have met the needs of all individuals due to different levels and types of delays, it appears to be broadly applicable for the majority of children with developmental delays in improving their adaptive skills toward a level of independence. This program may be a short-term, feasible, resource-light intervention that can greatly improve the functioning of children with developmental delays in LIMCs and can have a lasting impact on the quality of life for these children and their families.

Acknowledgment This project was supported by the Fogarty International Center/National Institutes of Health [5R21TW008436-02], USA.


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References Central Intelligence Agency. (2019). The World Factbook. Retrieved November 9, 2019, from https://www.cia.gov/library/ publications/resources/the-worldfactbook/geos/vm.html CESA 5. (2003). Portage guide: Birth to six: Activities and routines for preschoolers. Portage, Wisconsin: CESA 5. Einfeld, S. L., Stancliffe, R. J., Gray, K. M., Sofronoff, K., Rice, L., Emerson, E., & Yasamy, M. T. (2012). Interventions provided by parents for children with intellectual disabilities in low and middle income countries. Journal of Applied Research in Intellectual Disabilities, 25(2), 135-142. Emerson, E., Yasamy, M. T., & Saxena, S. (2012). Scaling up support for children with developmental disabilities in low‐ and middle‐income countries. Journal of Applied Research in Intellectual Disabilities, 25(2), 96-98. General Statistics Office. (2018). National Survey on People with Disabilities, 2016. Hanoi, Vietnam. Retrieved from https://www.unicef.

org/vietnam/media/2786/file/ Main%20report%20people%20 with%20disabilities%20survey.pdf Hunt, P. C. (2005). An introduction to Vietnamese culture for rehabilitation service providers in the United States. Culture and Disability: Providing Culturally Competent Services, 203-223. Le, H. M. (2013). Opening the gates for children with disabilities: An introduction to inclusive education in Vietnam. Washington DC: Aspen Institute. Retrieved from https://assets. aspeninstitute.org/content/uploads/ files/content/docs/agentorange/2013-10-20_Le_Minh_HangInclusive_Education_for_CWD_in_ Vietnam-EN.pdf Odom, S. L. (2003). Early intervention practices around the world. Baltimore, MD: Brookes Pub. Ramey, S. L., Ramey, C. T., & Lanzi, R. G. (2007). Early intervention: Background, research findings, and future directions. In J. W. Jacobson, J. A. Mulick, & J. Rojahn (Eds.), Handbook of intellectual and developmental disabilities (pp. 445-

463). New York, NY, US: Springer Publishing Co. Rosenthal, E. (2009). The rights of children with disabilities in Vietnam: Bringing Vietnam’s laws into compliance with the UN Convention on the Rights of Persons with Disabilities. Retrieved from http://www. disabilityrightsintl.org/wordpress/ wp-content/uploads/UNICEF_final_ legal_analysis_report_in_Vietnam1.pdf Shin, J. Y., & Nhan, N. V. (2009). Predictors of parenting stress among Vietnamese mothers of young children with and without cognitive delay. Journal of Intellectual and Developmental Disability, 34(1), 17-26. Shin, J. Y., Nhan, N. V., Lee, S.-B., Crittenden, K. S., Flory, M., & Hong, H. T. D. (2009). The effects of a home-based intervention for young children with intellectual disabilities in Vietnam. Journal of Intellectual Disability Research, 53(4), 339-352. Sparrow, S., Cicchetti, D., & Balla, D. (2005). Vineland Adaptive Behavior Scales (Vineland II): Survey interview form/caregiver rating form. Livonia, MN: Pearson Assessments.

Jin Y. Shin is an associate professor in the Department of Psychology at Hofstra University. She holds a PhD in Developmental Psychology from the University of Illinois at Chicago and completed her postdoctoral fellowship at the Rehabilitation Institute of Chicago. Shin received two grants from the Fogarty International Center to run home-visit early intervention programs for children with developmental delays in Vietnam, which led to successful completion of research programs in Hue and Hanoi. Shin’s career goals include promoting research and clinical work and advancing the field of disability and rehabilitation in Vietnam. She taught a class on developmental disabilities at Hue University of Medicine and Pharmacy under a Rotary Teacher Grant, focusing on early identification and intervention for children with developmental delays. She has also arranged numerous training programs in the United States and Vietnam to train Vietnamese researchers and clinicians. She has been active in continuing research programs that address parenting stress among parents of children with developmental delays and that seek to develop improved strategies for conducting early intervention programs for these children in Vietnam.

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PSYCHOLOGY FACULTY RESEARCH INTERESTS We hope you enjoyed reading this issue of Hofstra Horizons. The faculty in the Psychology Department are actively engaged in research in many diverse fields. Below is a sample of some of our faculty’s exciting research interests. Emily E. Barkley-Levenson Risky decision-making in adolescents and young adults

Brian D. Cox History of psychology; children’s metacognition; and memory Charles A. Dill Quantitative methods (general linear model) and personality (implementation intentions and goal-directed behaviors) Robin A. Flaton The experience of being a sibling to a person with an intellectual disability Jeffrey J. Froh Positive psychology-related topics, such as happiness, gratitude, and purpose

Kimberly A. Gilbert The phenotypic expression of children along the autism spectrum to further delineate early onset predictive behaviors of autism spectrum disorder

Rebecca Grossman Teams in the workplace (e.g., emergent states, team processes, measurement of team constructs); training (e.g., transfer of training, instructional features); and complex settings (e.g., multicultural, multiteam memberships)

Craig A. Johnson Topics in social cognition and intergroup processes, including stereotype development and human-animal relations Amy M. Masnick Numerical cognition in children and adults; scientific reasoning; and scientific literacy Paul J. Meller Divorce; conflict in relationships; high-conflict families; and forensic psychology Robert W. Motta Post-traumatic stress disorder (PTSD); secondary traumatization; and the impact of exercise on cognitive, emotional, and behavioral states

Sarah Novak The role of close relationships in promoting or inhibiting good health habits, with a focus on body weight and nutrition

Phyllis S. Ohr Early childhood development

Oskar Pineño Animal conditioning; human learning

Elisabeth Ploran Spatial cognition; spatial memory; perceptual decisions; describing cognitive deficits and addressing cognitive deficits in a tailored way Erin Reilly Shared risk and maintenance processes in eating disorders and anxiety; behavioral treatments for eating disorders; and best practices for research methods and statistics in the study of eating behaviors Nicholas Salter Diversity, equity, and inclusion in the workplace, particularly the challenges and opportunities minority employees experience at their jobs William C. Sanderson Treatment of anxiety disorders and depression; cognitive appraisal and emotion; evolutionary psychology Mitchell L. Schare General areas of anxiety treatment, trauma, and human sexuality

Comila Shahani-Denning The domain of employee selection as it is enhanced or hindered by social media, with a particular focus on LinkedIn

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Terri Shapiro Industrial/organizational psychology; leadership Sergei V. Tsytsarev Forensic psychology; addictions; cross-cultural psychology; and interviewing and counseling S. Stavros Valenti Development of career interest and science education; social behavioral development; social perception and interaction; ecological social psychology; perception of action in photographs Kristin M. Weingartner Perception; memory; text comprehension; visual word recognition; lexical ambiguity resolution; inference generation during reading

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Hofstra at a Glance LOCATION Hempstead, Long Island, 25 miles east of New York City. Telephone: 516-463-6600 CHARACTER A private, nonsectarian, coeducational university. PRESIDENT Stuart Rabinowitz, JD COLLEGES AND SCHOOLS Academic Health Sciences Center (Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Hofstra Northwell School of Nursing and Physician Assistant Studies at Hofstra University; School of Health Professions and Human Services); Frank G. Zarb School of Business; Fred DeMatteis School of Engineering and Applied Science; Hofstra College of Liberal Arts and Sciences (Peter S. Kalikow School of Government, Public Policy and International Affairs; School of Education; School of Humanities; Fine and Performing Arts; School of Natural Sciences and Mathematics); Honors College; Lawrence Herbert School of Communication; Maurice A. Deane School of Law; Hofstra University Continuing Education FACULTY There are 1,245 faculty members, of whom 485 are full-time. Ninety-two percent of full-time faculty hold the highest degree in their fields. STUDENT BODY Undergraduate enrollment of 6,498. Total University enrollment, including graduate, School of Law, and School of Medicine, is 10,804. Undergraduate male-female ratio is 45-to-55. PROGRAM OPTIONS Bachelor’s degrees are offered in about 165 program options. Graduate degrees, including PhD, EdD, PsyD, AuD, JD, and MD, advanced certificates and professional diplomas, are offered in about 175 program options. THE HOFSTRA CAMPUS With 117 buildings and 244 acres, Hofstra is a member of the American Public Gardens Association. LIBRARIES The Hofstra libraries contain 800,000+ volumes and provide 24/7 online access to more than 100,000 full-text journals and 200,000 electronic books. ACCESSIBILITY Hofstra is 100 percent program accessible to persons with disabilities. JANUARY AND SUMMER SESSIONS Hofstra offers a January session and three summer sessions between May and August.

Trustees of Hofstra University As of May 2020

OFFICERS Donald M. Schaeffer, Chair David S. Mack,* Vice Chair Michael Roberge,* Vice Chair Robert D. Rosenthal,* Vice Chair Martha S. Pope, Secretary Stuart Rabinowitz, President Alan J. Bernon,* Immediate Past Chair MEMBERS Kenneth Brodlieb Susan Catalano Michael P. Delaney* Arno H. Fried Leo A. Guthart Peter S. Kalikow* Arthur J. Kremer Diana E. Lake* Randy Levine* Elizabeth McCaul Stella Mendes* Janis M. Meyer* John D. Miller* Joanne Minieri* Marilyn B. Monter* Julio A. Portalatin* Samuel Ramos* Debra A. Sandler* Thomas J. Sanzone* Michael Seiman* Leonard H. Shapiro Joseph Sparacio* Steven C. Witkoff* Frank G. Zarb* DELEGATES George A. Giuliani, Speaker of the Faculty William Caniano, Chair, University Senate Executive Committee Craig Burnett, Chair, University Senate Planning and Budget Committee Kathleen Stanley,* President, Alumni Organization Tara Stark, President, Student Government Association Alexa Osner, Vice President, Student Government Association Wilbur Breslin, Trustee Emeritus John J. Conefry, Jr., Chair Emeritus Helene Fortunoff, Chair Emerita Lawrence Herbert,* Trustee Emeritus Florence Kaufman, Trustee Emerita Walter B. Kissinger, Trustee Emeritus Ann M. Mallouk,* Chair Emerita *Hofstra alumni

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The Effects of a Home-Based Intervention Conducted by College Students for Young Children With Developmental Delays in Vietnam See page 32.

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