Use of operational criteria in an office practice for diagnosis of children referred for evaluation of learning or behavior disorders

100 consecutively referred school-age children were evaluated for learning or behavior disorders. 45 children had one of three classical neurological syndromes of epilepsy, sensorineural deafness, or childhood migraine. The 26 children with epilepsy required medication adjustment to improve behavior or learning. Operational criteria for childhood depression, specific learning disability, developmental hyperactivity, and Gilles de la Tourette syndrome were used to establish the correct diagnosis in 55 children. 32 children had a single diagnosis, while 23 children fulfilled the criteria of two diagnostic categories. The diagnostic categorization permitted specific counseling of the child and family, development of a proper school program, and correct pharmacotherapy (when indicated).     

Measuring functional outcomes after prematurity: developmental impact of very low birth weight and extremely low birth weight status on childhood disability

Our purpose was to describe functional outcomes in essential activities in preschool, school-age, and adolescent children who were born very (<32 weeks gestation) and extremely (<28 weeks gestation) prematurely. Very low birth weight (VLBW; 1000-1499 g), or extremely low birth weight (ELBW;<1000 g) populations are the focus of our analysis. We describe models of disablement and enablement for specifying the complexity of childhood outcomes using a framework of pathophysiology, impairment, functional limitation and functional strengths, disability in social roles and social participation, societal limitations and environmental facilitators. Representative early childhood, preschool, school-age, and adolescent studies were examined in terms of describing children's functional strengths and challenges after VLBW and ELBW survival. In early childhood, disability was assessed by diagnosing neurosensory impairments and delays on developmental testing. Instruments for measuring functional status in essential activities of self-care, mobility, communication and learning are described. Rates of neurosensory disability in the first three years among recent ELBW survivors ranged from 9-26% for cerebral palsy, 1-15% for blindness, 0-9% for deafness, and 6-42% for evolving cognitive disability (MDI <70). Rates of preschool functional limitation were 5-27% motor, 5-30% self-care, and 5-22% communicative. Rates of school-age functional educational disabilities exceeded 50%. Rates of adolescent activity limitation were 13-32% and vocational limitations were 27-71%. By examining the functional strengths and challenges of children with major neurodevelopmental impairments after very or extremely preterm birth, we can examine causal pathways that lessen the risk of severe functional disability. Among children with mild to moderate disability, we can enhance functional outcomes, optimize community participation, and provide quality family supports. In order to assess the changing outcomes of this vulnerable population of survivors, combinations of clinical and survey based methodologies are required.     

The Clinical Challenge of Mentalization-based Therapy with Children Who are in “Pretend Mode”

ABSTRACT

The “pretend mode” is one of the so-called “pre-mentalizing modes of thinking”, which were first introduced by Target and Fonagy over 20 years ago. In a series of papers about play and reality, “pretend mode” thinking was understood as a mode of pre-mentalizing thinking which is typical in the early years, but which can reappear in a more problematic way in adults. Although the concept of pretend mode was first introduced in a developmental context, as a clinical term it has primarily been discussed in the context of adult or adolescent psychotherapy. This paper suggests that the pretend mode is a valuable clinical concept for therapists working with school-age children, but that its use in this context needs some clarification. After reviewing how pretend mode has been understood as a normal part of early development, this paper goes to demonstrate the various roles of pretend mode in clinical work with school-age children and sets out a number of clinical strategies that may be used in therapeutic work.     

Maternal depression and developmental disability: research critique

Maternal depression in families having a child with a disability has been the subject of considerable research over the past 25 years. This review was designed to describe the literature on maternal depression, critique its research methodology, identify consensus findings across studies, and make recommendations for future research. A particular emphasis is on the distinction between exhibiting depressive symptoms and meeting clinical criteria for a depressive disorder, how or whether research studies made this distinction, and implications for our understanding of maternal adaptation to disability in a family member. Of the 42 articles reviewed, only eight were clinically diagnosed depression; most of them used a scale rating depressive symptoms. Across the studies, mothers of children with disabilities generally exhibited a higher than average rate of depressive symptoms and are more at risk for clinical depression, but the incidence may be lower than reported in previous literature. Child behavior problems, maternal stress, coping style, and support were consistently associated with depressive symptoms. We conclude that we know relatively little about clinical depression in mothers of children with disabilities. The distinction between clinical depression and depressive symptoms may be important in conceptualizing how a child with a disability can influence family members and the nature of support that may need to be provided. Future research should incorporate gold standard diagnostic tools and assess history, severity, and type of depression. Research is also needed to study treatments to reduce the occurrence of both depressive symptoms and clinical depression.     

THE LIFE CYCLE AND DISABILITY: EXPERIENCES OF DISCONTINUITY IN CHILD AND FAMILY DEVELOPMENT

Clinicians are often asked to work with parents who have one or more children with specific disabilities. Disability within the family can have a dramatic impact on family interactions and functioning across the course of the family life cycle. The authors review the potential role of disability within a family system and make specific suggestions for working with a family or the child with the disability.     

Creating therapeutic realities via responsibility messages

Abstract

This paper proposes that operating from an ecosystemic epistemology does not preclude a family therapist from focusing on the individual responsibility of each family member. Rather, a systemic therapist can examine the family's pattern of distributing responsibility and map how this perpetuates the presenting problem. Examples from early, middle, and late therapy illustrate how a clinician can design interventions to encourage responsible behavior on the part of each individual, while being mindful of typical transactional patterns in the system     

Recognizing the role of parents in developmental outcomes: a systems approach to evaluating the child with developmental disabilities

When developmental concerns arise in children, a clinical assessment focuses on the child's developmental profile to achieve three goals (1) determine diagnosis, (2) develop interventions, and (3) evaluate progress. Parents often have needs during this time that are not addressed by professionals because of the exclusive focus on the child during the evaluation. In this article, we suggest that clinicians take a "systems" approach to the assessment process by recognizing how the well being of family members can impact a child with a developmental disability. We review systems theory and its conceptualization of individual functioning and discuss how parental well-being differs according to child diagnosis. Finally we suggest a systems-based model to use during the assessment process.     

Family as a factor in delinquency

50 adjudicated delinquents were given academic and psychological tests and a self-report of delinquency according to the learning disability/delinquency study of the National Criminal Justice Service of 1980. 31 learning disabled delinquents were identified. The test of proportions compared learning disabilities in delinquent (n = 31) and nondelinquent (ns = 24 and 43) samples. The Mann-Whitney U test compared the reported number of categories of delinquent behavior in the three groups. A typical delinquent of this rural area tends to be a white male with average or above intelligence and a learning disability. His family is large; his parents are divorced. He comes from a poorer economic and cultural background. A dysfunctional family can be a center wherein delinquency grows; on the other hand, a strong family can nurture and protect when peers and school fail.     

Rapid automatized naming in children referred for evaluation of heterogeneous learning problems: how specific are naming speed deficits to reading disability?

Because the Rapid Automatized Naming (RAN) test reliably predicts reading skill, it is typically viewed as a diagnostic indicator of risk for reading disability (RD). Since most of the work on naming speed has been undertaken within the framework of reading research, however, the extent to which poor RAN is specifically associated with RD or with learning impairment (LI) in general is uncertain. We tested the hypothesis that slow naming speed is specific to RD. Participants were 188 children (ages 7 to 11) referred for evaluation of learning problems. Receiver operating characteristic (ROC) analysis was used to evaluate the utility of the RAN task for classifying children in diagnostic groups. RAN was an excellent tool for detecting risk for learning problems in general, but it was much less effective at distinguishing LI children with and without RD from each other.     

Reflecting talks: a pedagogical model in the learning organization

The aim of the article is to deepen the understanding of how a pedagogical model for reflecting talks can be used in order to make sustainable learning part of the daily work in the learning organization. From an interactive research approach, we have together with a project management group in a European Social Fund project worked with sustainable learning and knowledge development. Empirical data has been collected at the implementation of ten reflecting talks about sustainable equality. The results of the study lead to a strategy for how sustainable learning can become part of the daily work at a workplace. The strategy is constituted by a pedagogical model for reflecting talks, which clearly shows how sustainable learning in an organization can be structured. The core of the pedagogical model for the reflecting talks where both practically applied and theoretically anchored knowledge are important components. The learning process is based on observation, reflection, analysis and discussion of concrete situations/events. The models rests on four basic conditions; pedagogical competence, a delimited problem area, the learning group and timeframes. The model can be used in the daily work at short dialogues or at more penetrating discussions.     

Facilitating the highly bonded cohort: Should more be done to anticipate and reduce the potential for hyper-cohesiveness and deindividuation in therapy training cohorts in universities?

Successfully facilitating learning for small therapy training programmes requires a special understanding of the psychological work of group processes. Students in therapy training spend almost every class together over two or more years. In these student groups, or cohorts, individuals manage themselves within a unique interpersonal and intragroup dynamic. Course instructors must develop their capacity to work effectively with this specific learning milieu. At the same time, the particular dynamics of the cohort context might not be understood by university management where increasingly few cohort contexts exist for students. Consequently, phenomena arising from the specialised nature of the group environment may not be well understood outside of the expertise of the course. In the first part of the paper, the international literature about learning in cohorts is reviewed. In the second part, this reflection is further developed to explore facilitation of a group that has some features of what might be described as negative cohesiveness, or what is described in family theory as enmeshment. Some consideration as to how to anticipate and off-set potential difficulties for groups in therapy training courses is also contributed.     

The madman theory of war: a possible application in therapy

In therapeutic work a systemic approach has characteristically focused on the family or marital system. In this paper the author focuses on the patient/health care system in a particular case and argues that chronic disability can be seen as a systemic feature rather than a characteristic of the individual patient. A strategy is taken from the field of international conflict and its therapeutic value is explored.     

Values for comparison of WAIS-III index scores with overall means

The Wechsler Adult Intelligence Scale--Third Edition (WAIS-III; Wechsler, 1997b) provides factor-based index scores but allows only for pairwise comparison of these scores, producing inflated Type I error rates and reducing profile interpretability. This article provides tables for simultaneous comparison to the overall mean index score, thus reducing error rates and aiding interpretation. The Working Memory Index or Processing Speed Index can also be specifically compared when an individual is believed to have a condition, such as a learning disability or traumatic brain injury, associated with the selective depression of these indexes. Tables for the infrequency of specific differences are also provided, allowing the practitioner to note how unusual an obtained difference is in the general population.     

学习不良儿童家庭资源的元分析

对过去20年关于学习不良儿童家庭资源的研究结果进行的元分析显示,儿童各种家庭资源的效应值变异程度不大。总体来说,学习不良儿童和一般儿童的家庭资源差异显著。一般儿童的父母文化程度和教养方式优于学习不良儿童的父母文化程度和教养方式。但是,两类儿童的父母期望没有显著差异。     

Combating Foster Care Drift: An Ecosystemic Treatment Model For Neglect Cases

The neglect of children may take many forms, but always represents the diminished capacity of the entire system of which the children are a living part. Child, parent, family, neighborhood, and community variables mutually influence one another. Once children are removed from a home, these same individual, relational, and contextual factors may result in foster placements of indefinite term and goals. Families are not reunited nor are the children legally freed to be placed in permanent homes. Because of the multiplicity of transacting influences there needs to be a stage-wise, systemic approach to remediation. This begins with crisis intervention and life stabilization. Later it includes more traditional family therapy work. However, the marital and family therapist contributes substantially at each stage.     

Neophobia is negatively related to reversal learning ability in females of a generalist bird of prey,the Chimango Caracara, <Emphasis Type="Italic">Milvago chimango</Emphasis>

In an ever-changing environment, the ability to adapt choices to new conditions is essential for daily living and ultimately, for survival. Behavioural flexibility allows animals to maximise survival and reproduction in novel settings by adjusting their behaviour based on specific information and feedback acquired in their current environments. However, a growing body of evidence indicates that an individual’s personality type can limit the extent to which the individual might behave flexibly, by influencing the way an individual pays attention to novelty and how much information it collects and stores, which in turn affects the individual’s decision-making and learning process. In this study, the behavioural flexibility of a generalist predator, the Chimango Caracara, Milvago chimango, was analysed using the reversal learning paradigm, focusing on the comparison between age classes, and the relation of learning flexibility with a personality trait, the level of neophobia. Due to the low number of male individuals captured, this study was carried out only with female birds. The results showed that age had no significant effect either on the acquisition of a stimulus-reward association, or on the capacity of reversing this previously learned association. Reversal of the response was a harder task for these birds in comparison with the initial acquisition process. The individual’s performances in the learning tasks seemed to be uncorrelated with each other, suggesting that they involve different neural mechanisms. Contrary to the general pattern observed in the majority of previous work on personality and cognition in non-human animals, the level of neophobia did not correlate with the initial associative learning performance in both adults and juveniles, yet it showed a significant negative relationship with reversal learning ability, mainly in the regressive phase of this task, for the two age classes. Our results suggest that the predatory and generalist lifestyle of female individuals of M. chimango along with the selective pressures of the environment of the individuals studied might play a critical role in the degree and direction of the linkage between novelty response and learning flexibility observed in this study.     

One articulation of the structural family therapy model: a biobehavioral family model of chronic illness in children

This article presents the Biobehavioral Family Model (BBFM), which, as a general systems model, has the advantage of being conceptually neutral with respect to health versus pathology, and promotes integration of individual, family and social levels of theory. The BBFM provides a heuristic theory of pathways by which family patterns of interaction and individual family member physiological function influence one another. The BBFM also can be extrapolated to the clinical domain, providing a developmental biopsychosocial approach to assessment and intervention in childhood chronic illness or disability. A case illustration demonstrates clinical application.     

Values in Family Therapy Practice and Research: An Invitation for Reflection

Values have been shown to be a pervasive part of both marriage and family therapy (MFT) clinical practice and research. Yet, many therapists and researchers remain unclear about how values affect their work. This article examines the influence of Western philosophical assumptions and therapy traditions in light of current understandings of values in therapy. The influence of values in MFT research processes is similarly examined. Implications for how family therapy professionals can be more reflective and sophisticated in their understanding of values in clinical practice and scientific inquiry are discussed. Suggestions for addressing values in MFT training also are given.     

A test of foreign language acquisition: paired‐association learning

This experiment investigated college student difficulties with foreign language acquisition. We developed a word‐sound, paired‐associates learning test that discriminated 92% of the control participants and 95% of the experimental participants. The results are interpreted in terms of an associative model of foreign language learning disability. We discuss how to integrate the test into a larger diagnostic battery for predicting the facility with which a person will be able to learn a foreign language. Copyright © 2002 John Wiley & Sons, Ltd.