Transforming mental health care for children and their families

In April 2002, the President's New Freedom Commission on Mental Health was created by executive order to study the mental health care delivery system in our nation and to make recommendations for improvements so that individuals with serious mental disorders can live, work, learn, and fully participate in their homes and communities. In its report, "Achieving the Promise: Transforming Mental Health Care in America," the commission provided strategies to address critical infrastructure, practice, and research issues. This article focuses on the work of the commission's Subcommittee on Children and Families, describing its vision for mental health service delivery for children and providing suggestions for strengthening community-based care for youths with or at risk of behavioral health disorders. Training, research, practice, and policy implications for psychologists are discussed.     

Characteristics of auditory agnosia in a child with severe traumatic brain injury: a case report

We present a case that is unusual in many respects from other documented incidences of auditory agnosia, including the mechanism of injury, age of the individual, and location of neurological insult. The clinical presentation is one of disturbance in the perception of spoken language, music, pitch, emotional prosody, and temporal auditory processing in the absence of significant deficits in the comprehension of written language, expressive language production, or peripheral auditory function. Furthermore, the patient demonstrates relatively preserved function in other aspects of audition such as sound localization, voice recognition, and perception of animal noises and environmental sounds. This case study demonstrates that auditory agnosia is possible following traumatic brain injury in a child, and illustrates the necessity of assessment with a wide variety of auditory stimuli to fully characterize auditory agnosia in a single individual.     

Implementation of a comprehensive schoolwide behavioral intervention: The ABC program

The Academic and Behavioral Competencies (ABC) Program, a schoolwide program to reduce classroom disruption and encourage rule following, academic task completion, and homework completion, is described. The program was initially developed and implemented in an elementary school with a high-risk population. Data from teachers, parents, and children indicate high levels of satisfaction with the program. In addition, unobtrusive measures of program impact, reported as reductions in referrals to the principal's office, suspensions, and increases in homework completion rates relative to the year prior to implementation of the program, suggest a preliminary positive impact of the program. A replication is reported for another school district, with teacher evaluations of satisfaction and effectiveness reported, supporting the flexibility and adaptability of the program. Although the present article does not constitute a systematic evaluation of the ABC Program, it presents preliminary data on the process of implementation and stakeholder satisfaction.     

Treatment of pharmacotherapy-refractory posttraumatic stress disorder among Cambodian refugees: a pilot study of combination treatment with cognitive-behavior therapy vs sertraline alone

Cambodian refugees with posttraumatic stress disorder (PTSD) represent a cohort in severe need of treatment, but little information is available to guide treatment choices. We selected a sample of pharmacotherapy-refractory individuals to test the efficacy of combination treatment with sertraline and cognitive-behavior therapy (CBT) for treating PTSD. Participants in this pilot study were ten Khmer-speaking women who had been at a mean age of 22-26 years during the Pol Pot period (1975-1979). These patients were randomly assigned to either sertraline alone or combined treatment. We found that combined treatment offered additional benefit in the range of medium to large effect sizes for PTSD and associated symptoms. Our findings indicate that substantial gains can be achieved by adding CBT to pharmacotherapy for PTSD, and that a program of CBT emphasizing information, exposure, and cognitive-restructuring can be successfully modified for Khmer-speaking refugees.     

Promoting responsible conduct in research through “survival skills” workshops: Some mentoring is best done in a crowd

For graduate students to succeed as professionals, they must develop a set of general "survival skills". These include writing research articles, making oral presentations, obtaining employment and funding, supervising, and teaching. Traditionally, graduate programs have offered little training in many of these skills. Our educational model provides individuals with formal instruction in each area, including their ethical dimensions. Infusion of research ethics throughout a professional skills curriculum helps to emphasize that responsible conduct is integral to succeeding as a researcher. It also leads to the consideration of ethical dimensions of professional life not covered in traditional ethics courses.     

Self as verb and the metaphor of dance: An explanation of the self discovery experience within a constructivist framework

The concept of self discovery within a constructivist framework is difficult to explain given the central assumption of constructivism that self is a created construct rather than an entity to be discovered. Two problems are identified as impediments to constructivist accounts of the self discovery experience: first, their failure to adequately account for the embodied experience of self, and second, the difficulties inherent in using self as a noun to express a process.
It is proposed that if self is considered as a verb, as the action of a body-subject, the verbal contortionism of referring to self as a process in a language that places self as an entity may be overcome. The notion of self as verb places the individual firmly in the role of active embodied participant in the experience of self. The metaphor of "self'" as "dance" is explored to emphasize the materiality of the human animal that is argued to be central to the experience of self discovery.     

The interaction of pronunciation rules and lexical representations in reading aloud

Two experiments examined the role of pronunciation rules and of lexical information in pronouncing letter strings. In Experiment 1, subjects pronounced pseudowords varying in the strength of the rules needed to pronounce them, as well as in the availability of a lexical model. In Experiment 2, the stimuli were words varying in rule strength and in usage frequency. The pronunciation times from both experiments displayed an interaction between rules and lexical information: When the rules necessary were strong, the relative availability of lexical information was less important than when the rules were weak. The results were discussed with respect to both traditional dual-process models of pronunciation and models proposing the use of lexical analogies.     

Neural correlates of intertemporal choice in aggressive behavior

People often have to make decisions between immediate rewards and more long-term goals. Such intertemporal judgments are often investigated in the context of monetary choice or drug use, yet not in regard to aggressive behavior. We combined a novel intertemporal aggression paradigm with functional neuroimaging to examine the role of temporal delay in aggressive behavior and the neural correlates thereof. Sixty-one participants (aged 18–22 years; 37 females) exhibited substantial variability in the extent to which they selected immediate acts of lesser aggression versus delayed acts of greater aggression against a same-sex opponent. Choosing delayed-yet-more-severe aggression was increased by provocation and associated with greater self-control. Preferences for delayed aggression were associated with greater activity in the ventromedial prefrontal cortex (VMPFC) during such choices, and reduced functional connectivity between the VMPFC and brain regions implicated in motor impulsivity. Preferences for immediate aggression were associated with reduced functional connectivity between the VMPFC and the frontoparietal control network. Dispositionally aggressive participants exhibited reduced VMPFC activity, which partially explained and suppressed their preferences for delayed aggression. Blunted VMPFC activity may thus be a neural mechanism that promotes reactive aggression towards provocateurs among dispositionally aggressive individuals. These findings demonstrate the utility of an intertemporal framework for investigating aggression and provide further evidence for the similar underlying neurobiology between aggression and other rewarding behaviors.     

Death of a Salesman: A clinical look at the Willy Loman family

A separation-individuation model is used to explore the dynamics of the Willy Loman family as depicted in the play,Death of a Salesman. The concept of differentiation is discussed, with examples from the play used to magnify the applicability of this construct. The family is viewed in three-generational context, using Erickson's definition of identity as it relates to the continuity between the past, present and future. The low level of differentiation inexorably leads to a void of intimacy, reflected in the form of emotional isolation, inability to tolerate differences and lack of problem solving skills. Finally, the discussion accents the difficulties experienced by the Loman children to separate and in individuation.