Pharmacological interventions in autism: theoretical and practical issues

Focused on issues of drug treatment in relation to autism. Pharmacological treatment studies in autism are complicated by various factors including a tremendous range of syndrome expression, a lack of robust animal models of the disorder, and various methodological problems. Theories have tended to follow treatments, and various neurochemical systems have been the focus of study. Neurochemical systems potentially implicated include those involving dopamine, norepinephrine, serotonin, and neuropeptides. The dopaminergic system has been the most extensively studied. Treatments developed are effective relative to certain disabling symptoms but "core" problems (e.g., in social relatedness and communication) appear less responsive to medications. The development of new approaches to assessment, including integration of behavioral and pharmacological approaches, is an important research priority.     

The theoretical question of the practical considerations: Some Carnapian reflections

In spite of some interesting recent research, Carnap’s emphasis on the bearing of the practical features on the constitution of knowledge is not duly appreciated yet. A few decades before the emerging thrill about the pragmatic encroachment in epistemology, it was Carnap who, inspired by the accomplishments of the pragmatists, had made some lasting remarks about the bearing of the essentially non-epistemic factors on the formation of knowledge. To be more precise, he not only took the practical factors into account in his theory of knowledge, but also made some efforts at bridging the gap between semantics and pragmatics in the way of dealing with some fundamental epistemological questions. Just as was the case with the shift from syntax to semantics, this underestimated pragmatic move brings about a smooth and flowing change, with both gains and losses. The influence of this pragmatic move in coming to a comprehensive theory of knowledge is to be exposed in this paper.     

Some metrical issues with meta-analysis of therapy effects

Two metrical issues, both concerning the index of effect size used in meta-analyses of therapy effects, are discussed with reference to such analyses. The first issue refers to use of the standard deviation of change scores as a metrical unit, and the conclusion is that the standard deviation of unadjusted post-test scores should be used instead. The second issue concerns measurement errors, and it is argued that the metrical unit—irrespective of which kind of variability metric is chosen—should be corrected for such errors, hence expressing each therapy effect relative to an estimated true rather than observed unit. It is proposed that a set of metrical alternatives should be used in a meta-analysis, so that the analysis is performed for each alternative and the results are compared across the alternatives.     

Some unresolved issues in philosophy and psychology: their implications for therapy

This paper is divided into two interrelated sections: the first section examines the scientific status of mainstream Western psychology. It will also consider the major arguments concerning the relationship of mainstream Western psychology to philosophy—in particular to metaphysics and the philosophy of science. It will be argued that psychology has turned away from its past philosophical heritage and has thus, short-changed itself by avoiding the very issues, which form an integral part of one's subjective and existential world and of the therapeutic process. The second section argues that, to a large measure the contemporary approaches to counselling and psychotherapy have moved away from the scientific ideologies, which guide research within mainstream Western psychology. Over the last 30 years or more, counselling and psychotherapy as ‘disciplines’ have proliferated into several sub-disciplines. This has made it difficult, if not impossible, to determine their pedigree and parentage. Although a great deal of ingenuity has gone into the construction of such new therapies, very little effort has gone into testing their validity. Unless serious attempts are made to bring about a rapprochement, it is likely to lead to a state of ‘epistemological anarchy’, or, anything goes.     

Conditioned reinforcement: Experimental and theoretical issues

The concept of conditioned reinforcement has received decreased attention in learning textbooks over the past decade, in part because of criticisms of its validity by major behavior theorists and in part because its explanatory function in a variety of different conditioning procedures has become uncertain. Critical data from the major procedures that have been used to investigate the concept (second-order schedules, chain schedules, concurrent chains, observing responses, delay-of-reinforcement procedures) are reviewed, along with the major issues of interpretation. Although the role played by conditioned reinforcement in some procedures remains unresolved, the results taken together leave little doubt that the underlying idea of conditioned value is a critical component of behavior theory that is necessary to explain many different types of data. Other processes (marking, bridging) may also operate to produce effects similar to those of conditioned reinforcement, but these clearly cannot explain the full domain of experimental effects ascribed to conditioned reinforcement and should be regarded as complements to the concept rather than theoretical competitors. Examples of practical and theoretical applications of the concept of conditioned reinforcement are also considered.     

Using doctor-patient communication to affect patients' lifestyles. theoretical and practical implications

Abstract

Physicians very often do not perceive themselves as being efficient in affecting patients' life style. The aim of this article is to elucidate theoretical constructs and models in health education and their practical implications for individual health counselling in daily work as a guidance for physicians. The current most commonly used strategies are giving information and exhorting people, which have a limited ability to change peoples' behaviour. Derived from current behavioural constructs and models in health education - such as the health belief model, social learning theory, health beliefs, self-efficacy, self-determination theory - principles for successful strategies are described: to use patient-centredness instead of directing, to encourage patients to reflect and decide on their behavior, to find out the patient's readiness to change, to present knowledge as neutral facts instead of valuations, to focus on the actual behaviour instead of information-giving, to highlight patients' health beliefs and to discuss the advantages and disadvantages which the patients experience with their life style. The article concludes with a comprehensive model for individual health counselling in consecutive steps.     

Methodological and theoretical issues in neuropsychological assessment

While there are philosophical and theoretical differences between neuropsychologists and behavior therapists, it is suggested that a significant reconciliation can be achieved in regard to assessment and treatment of the brain-damaged patient. While brain damage is often viewed as an irreversible disorder, there is evidence that substantial recovery of function can occur, particularly when adequate retraining is provided. There are practical and empirical considerations that suggest that neuropsychological tests are currently the best tools available for behavioral assessment of brain-damaged patients. However, the results of these tests can be used not only diagnostically but also to identify target behavioral deficits that may be rehabilitated through systematic retraining efforts. Such rehabilitation efforts can be optimally planned, implemented, and evaluated through an alliance between the neuropsychologist, who identifies the ability and deficit pattern, and the behavior therapist, who devises and evaluates the retraining program. It is possible that the successes of behavior therapy in numerous clinical and educational applications can be repeated in the cases of brain-damaged patients. However, such success would appear to be contingent on appreciation of the high degree of specificity often seen in neurological deficit patterns and the great complexities involved in the relationships between brain function and behavior.     

Family sculpting: II. Some practical examples

This paper reviews a number of practical examples of family sculpting to illustrate possibilities for its use described in a general way in an earlier companion article (Journal of Family Therapy (1981) 3: 341–352). Examples are considered first in relation to generic practical possibilities for sculpting: structural analysis and diagnosis, the inescapability of the concrete, the portrayal of ambiguity. A second set of examples is considered in relation to major practical contexts of sculpting: with children, with students, with workers. The paper concludes with a discussion of the complexity of family sculpting and a comparison of the structural interpretation of sculpting offered here with Papp et al. 's notion of choreography.     

Empirical and theoretical issues in the perception of time to contact.

Four questions concerning the perceptual source of information about time to contact (tc) are addressed: (a) What conditions are required for the optic variable tau to play a role in the perception of tc? (b) When these conditions are met, does tau alone provide sufficient information for accurate timing of interceptive actions? (c) Does a distance divided by velocity account of tc perception provide a convincing alternative to an account that is based on tau? (d) Is there any empirical evidence that distinguishes the two accounts? A "global" type of tau variable and a "local" type of tau variable are distinguished, each with different limitations. The discussion is largely concerned with local tau variables, 2 versions of which are identified. It is concluded that tau alone cannot provide sufficient information for skilled timing. An extended tau-based account presented in an earlier article (Tresilan, 1990) is discussed. It is argued that no extant empirical data can distinguish the extended account from the distance divided by velocity account.