Conceptualising,designing and drafting a monthly multi-family therapy programme and manual for adolescents with anorexia nervosa

The written transmission of therapists' expertise in manuals is an important issue which is highlighted in the literature. Manuals are essential for research, training and therapeutic guidance. However, the conceptualisation, design and drafting of therapy manuals have received little attention. Our team conceptualised and designed a 10-monthly session multi-family therapy programme for adolescents suffering from anorexia nervosa. This paper presents the methodology used to evolve from training and theoretical models to designing a programme and drafting the accompanying manual. We then describe how our team reached a consensus regarding the role to be attributed to food-related symptoms in the programme. These arduous tasks were rewarded by fruitful discussions among team members, which led to a shared theory of treatment. The methodology presented here is drawn from both the experience of specialised teams and from that of families in providing care to adolescents with anorexia nervosa.     

The effect of cognitive behavior therapy on decision making in adolescents who self-harm: a pilot study

Research shows poor decision making in adolescents who self-harm and a positive correlation between decision-making abilities and duration since last self-harm episode. This exploratory study investigated whether decision making in self-harming adolescents could be improved through treatment with a novel cognitive behavior therapy (CBT). It also investigated whether improvement in decision making following treatment was linked to self-harm cessation. Adolescent self-harmers receiving CBT (n = 24) or no treatment (n = 9) and healthy controls (n = 22) were longitudinally compared on the Iowa gambling task (IGT). Significant IGT improvements were only observed for adolescents who self-harm following CBT. CBT may benefit adolescent self-harmers and generate decision-making improvements.     

Recovery from object substitution masking induced by transient suppression of visual motion processing: a repetitive transcranial magnetic stimulation study

Object substitution masking is a form of visual backward masking in which a briefly presented target is rendered invisible by a lingering mask that is too sparse to produce lower image-level interference. Recent studies suggested the importance of an updating process in a higher object-level representation, which should rely on the processing of visual motion, in this masking. Repetitive transcranial magnetic stimulation (rTMS) was used to investigate whether functional suppression of motion processing would selectively reduce substitution masking. rTMS-induced transient functional disruption of cortical area V5/MT+, which is important for motion analysis, or V1, which is reciprocally connected with V5/MT+, produced recovery from masking, whereas sham stimulation did not. Furthermore, masking remained undiminished following rTMS over the region 2 cm posterior to V5/MT+, ruling out nonspecific effects of real stimulation and confirming regional specificity of the rTMS effect. The results suggest that object continuity via the normal function of the visual motion processing system might in part contribute to this masking. The relation of these findings to the reentrant processing view of object substitution masking and other visual phenomena is discussed.     

Internal stress and defect-related free volume in submicrocrystalline Ni studied by neutron diffraction and difference dilatometry

A combined study of neutron diffraction and difference dilatometry on submicrocrystalline Ni prepared by high pressure torsion aims at studying the anisotropic behaviour during dilatometry and its relation to internal stress and structural anisotropy. Macroscopic stresses were undetectable in the dilatometer samples. Along with specific tests such as post cold-rolling, this shows that an observed anisotropic length change upon annealing is not caused by internal stress, but can be explained by the inherent microstructure, i.e. the anisotropic annealing of relaxed vacancies at grain boundaries of shape-anisotropic crystallites.     

Assessing ASD in Adolescent Females with Anorexia Nervosa using Clinical and Developmental Measures: a Preliminary Investigation

The aim of this study was to use standardised, clinical assessment tools to explore the presence of Autism Spectrum Disorder (ASD) symptoms in a sample of adolescent females with Anorexia Nervosa (AN), receiving either day-patient or inpatient treatment for their eating disorder and to determine whether any such symptoms were present during the early developmental period, a requirement for a diagnosis of ASD. Using a cross-sectional design, 40 females aged between 12 and 18 were recruited from inpatient and day-patient eating disorder services. All participants had a diagnosis of AN and were assessed for symptoms of ASD using the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2). If participants scored at or above clinical cut-off on the ADOS-2, their parents were asked to complete the Developmental, Dimensional and Diagnostic Interview, short version (3Di-sv). Of the 40 participants assessed, 21 scored above cut-off on the ADOS-2. When developmental history was obtained, only four participants scored above cut-off on all sub-scales of the 3Di-sv, thus meeting full research criteria for ASD. This study suggests that 10% of adolescents with AN from inpatient or day-patient settings may have diagnosable ASD, while a further 40% may show symptoms of ASD, which may arise from the ill-state of AN or are not supported by parental report.     

DEVELOPMENT OF SPONTANEOUS MANDING IN LANGUAGE DEFICIENT CHILDREN

Six institutionalized children, aged 7–11, with little or no spontaneous vocal manding, were trained to request food items under appropriate natural conditions when snacks were presented. “I want a” was appropriate when an adult presented food in the playroom. “Out” was appropriate when the items were displayed in the hallway, across a half-door barrier from the child. A sequence of steps was trained, through increasingly naturalistic setting and cuing conditions. The two mands were trained in sequence, not concurrently. To encourage “spontaneous” productions, no vocal cuing was provided by the adult. After criterion performance in each step, several probe sessions were conducted for various cuing conditions, adults, and settings. Probes after imitation training showed no spontaneous manding. Thus, failure of manding was not due to production difficulties. In probes after training for “approximately” natural cues, most children showed little transfer to the natural cues. This implies that training for the specific appropriate cues may often be required. However, good transfer generally occurred across persons, and from training room to playroom. Probes also showed that most children did not use one of the trained mands in the stimulus conditions that were appropriate for the other mand. Thus, adding a second mand did not generally disrupt use of the first. However, significant disruption occurred for two children. Finally, at the end of training, extinction training was given for one mand in one setting. Performance of the other mand was litle affected. In sum, the appropriate form of a mand depends on specific stimulus and setting characteristics, and these characteristics must be considered in training.     

Parent-Reported Behavioral and Emotional Responses of Children to Disaster and Parental Psychopathology

Child disaster mental health research has been largely limited by investigation of one disaster at a time and inconsistent methods across different studies. This study assessed 160 survivors of 3 disasters with structured diagnostic interviews, asking about the behavioral and emotional disaster reactions of their 266 children, ages 3–17. Most children had ≥1 postdisaster behavior change or disaster-related posttraumatic stress symptom. The children’s postdisaster behavioral and emotional problems were associated with parental postdisaster psychopathology. The results underscore the importance of asking disaster survivors about their children’s disaster reactions and considering parental disaster experiences and reactions in addressing their children’s reactions.     

Dorsal and ventral visual streams: Typical and atypical development

The literature on visuospatial processing describes two distinct pathways within the brain: a dorsal route extending from the visual cortex into the parietal lobes that is critical for spatial processing and a ventral route extending from the visual cortex into the temporal lobes that is critical for form perception. These visual streams appear to differ in their developmental trajectories and their vulnerabilities to diverse neurodevelopmental conditions. The present work aims to investigate development and vulnerability in two aspects of dorsal and ventral visual-stream function, namely attention to location and attention to identity. In Study 1, we compare typically-developing (TD) youth aged 9 to 16 years with young adults aged 18 to 22 years on computerized location and identity tasks. In Study 2, we compare children and adolescents who have congenital hypothyroidism (CH), a pediatric endocrine disorder, with age-matched TD controls on the same tasks. The results from Study 1 show that the youths were less accurate than the adults at judging identity, whereas both groups were equally accurate at judging location. The results from Study 2 show that the youths with CH were slower but not less accurate than the TD youths in making both identity and location judgments. The results are interpreted as signifying later development of ventral (identity) stream functions compared to dorsal (location) but equal vulnerability of both functions in CH.