Concordance Between Parent Reports of Children's Mental Health Services and Service Records: The Services Assessment for Children and Adolescents (SACA)

The concordance between parent reports of children's mental health services and medical and administrative service records were assessed in a field test of the Services Assessment for Children and Adolescents (SACA) interview instrument. Service use reports from primary caregivers, usually mothers, for their child's emotional or behavioral problems were compared against inpatient, outpatient, and school records in St. Louis, one of the pilot sites for the Multi-Site Study of Service Use, Need, Outcomes and Costs in Child and Adolescent Populations (UNOCCAP). A global any use service variable, comprised of inpatient, outpatient, and school reports, yielded an overall service use concordance kappa of .76 between parent reports and records. Parent reports of inpatient hospitalization services using the SACA yielded the highest agreement with medical records, with kappa statistics of 1.00 for use of any inpatient hospital care and for medication use. Parent reports of specific inpatient services concurred with medical records more moderately, yielding kappas from .50 to .66. Reports of any outpatient mental health services yielded variable rates of agreement, with kappas ranging from .67 for any use of outpatient care, to .66 for medication use, to negligible kappas for specific treatments. Parent reports of school services were weakly related to records for most services, except for moderate agreement (.48) on placement in special classrooms for emotional or behavioral problems. Family burden or impact discriminated more powerfully than other variables between respondents who concurred with records and those who did not.     

Perceiving surfaces in depth beyond the fusion limit of their elements

An isolated dot appears double outside a small disparity range called Panum's fusional area. In random-dot stereograms (RDSs), however, this doubling, or diplopia of dot elements is not evident at any disparity. Nevertheless, depth is perceived up to disparities that greatly exceed Panum's fusional limit. Either one is unaware of dot diplopia at disparities exceeding Panum's fusional limit or the fusion limit is extended. To examine these possibilities, we developed a novel RDS in which dichoptically color-coded dots have a distinctive color when fused, and return to their intrinsic colors when diplopic. We measured the fusion limit of dots in this RDS, and compared it to the patent stereopsis limit of the perceived surface in similar RDSs. We found that the fusional area of dots in the RDS was comparable to Panum's fusional area. Furthermore, there was clear dissociation between the fusion limit and the patent stereopsis limit in the RDS. We conclude that the elements composing a surface are not necessarily fused when a large disparity surface is perceived in depth.     

Language and modeling word problems in mathematics among bilinguals

The study was conducted to determine whether the language of math word problems would affect how Filipino-English bilingual problem solvers would model the structure of these word problems. Modeling the problem structure was studied using the problem-completion paradigm, which involves presenting problems without the question. The paradigm assumes that problem solvers can infer the appropriate question of a word problem if they correctly grasp its problem structure. Arithmetic word problems in Filipino and English were given to bilingual students, some of whom had Filipino as a first language and others who had English as a first language. The problem-completion data and solution data showed similar results. The language of the problem had no effect on problem-structure modeling. The results were discussed in relation to a more circumscribed view about the role of language in word problem solving among bilinguals. In particular, the results of the present study showed that linguistic factors do not affect the more mathematically abstract components of word problem solving, although they may affect the other components such as those related to reading comprehension and understanding.     

DSM-III and the revolution in the classification of mental illness

A revolution occurred within the psychiatric profession in the early 1980s that rapidly transformed the theory and practice of mental health in the United States. In a very short period of time, mental illnesses were transformed from broad, etiologically defined entities that were continuous with normality to symptom-based, categorical diseases. The third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III) was responsible for this change. The paradigm shift in mental health diagnosis in the DSM-III was neither a product of growing scientific knowledge nor of increasing medicalization. Instead, its symptom-based diagnoses reflect a growing standardization of psychiatric diagnoses. This standardization was the product of many factors, including: (1) professional politics within the mental health community, (2) increased government involvement in mental health research and policymaking, (3) mounting pressure on psychiatrists from health insurers to demonstrate the effectiveness of their practices, and (4) the necessity of pharmaceutical companies to market their products to treat specific diseases. This article endeavors to explain the origins of DSM-III, the political struggles that generated it, and its long-term consequences for clinical diagnosis and treatment of mental disorders in the United States.     

State-dependent thinking: a comparison of waking and dreaming thought

Thinking is known to be state dependent but a systematic study of how thinking in dreams differs from thinking while awake has not been done. The study consisted of analyzing the dream reports of 26 subjects who, in addition to providing dream reports also provided answers to questions about their thinking within the dream. Our hypothesis was that thinking in dreams is not monolithic but has two distinct components, one that is similar to wake-state cognition, and another that is fundamentally different. We found that cognition within a dream scenario was similar to that of wake-state cognition, but that thinking about the scenario itself was deficient and very different than wake-state thinking.     

The capacity to forgive: intrapsychic and developmental perspectives

The topic of forgiveness, despite its importance for the continuity of relationships and for the mental health of the aggrieved party, is relatively neglected in the psychoanalytic literature, perhaps because it is often seen as the province of religion and carries the connotation of reaction formation and inauthenticity. However, genuine forgiveness involves significant intrapsychic work, conscious and unconscious working through of one's anger, and putting the offense into the context of an integrated view of the whole person of the offender. Early developmental structures are the ground on which the relative ability to let go of a grievance depends. While later motives and defenses (e.g., fear of retraumatization, avoidance of shame) may also play a role, these early structures are primary. They are described here in terms of attainment of the depressive position and the development of a sense of secure attachment, the capacity to mentalize, and the ability to mourn.     

Brain network interactions in auditory, visual and linguistic processing

In the paper, we discuss the importance of network interactions between brain regions in mediating performance of sensorimotor and cognitive tasks, including those associated with language processing. Functional neuroimaging, especially PET and fMRI, provide data that are obtained essentially simultaneously from much of the brain, and thus are ideal for enabling one to assess interregional functional interactions. Two ways to use these types of data to assess network interactions are presented. First, using PET, we demonstrate that anterior and posterior perisylvian language areas have stronger functional connectivity during spontaneous narrative production than during other less linguistically demanding production tasks. Second, we show how one can use large-scale neural network modeling to relate neural activity to the hemodynamically-based data generated by fMRI and PET. We review two versions of a model of object processing - one for visual and one for auditory objects. The regions comprising the models include primary and secondary sensory cortex, association cortex in the temporal lobe, and prefrontal cortex. Each model incorporates specific assumptions about how neurons in each of these areas function, and how neurons in the different areas are interconnected with each other. Each model is able to perform a delayed match-to-sample task for simple objects (simple shapes for the visual model; tonal contours for the auditory model). We find that the simulated electrical activities in each region are similar to those observed in nonhuman primates performing analogous tasks, and the absolute values of the simulated integrated synaptic activity in each brain region match human fMRI/PET data. Thus, this type of modeling provides a way to understand the neural bases for the sensorimotor and cognitive tasks of interest.