Applying evidence to support ethical decisions: Is the placebo really powerless?

Using placebos in day-to-day practice is an ethical problem. This paper summarises the available epidemiological evidence to support this difficult decision. Based on these data we propose to differentiate between placebo and “knowledge framing”. While the use of placebo should be confined to experimental settings in clinical trials, knowledge framing — which is only conceptually different from placebo — is a desired, expected and necessary component of any doctor-patient encounter. Examples from daily practice demonstrate both, the need to investigate the effects of knowledge framing and its impact on ethical, medical, economical and legal decisions. An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research Today,” held in Warsaw, Poland on 12–13 April, 2003.     

Components of attentional bias to threat in high trait anxiety: Facilitated engagement, impaired disengagement, and attentional avoidance

There is a wealth of evidence demonstrating enhanced attention to threat in high trait anxious individuals (HTA) compared with low trait anxious individuals (LTA). In two experiments, we investigated whether this attentional bias is related to facilitated attentional engagement to threat or difficulties disengaging attention from threat. HTA and LTA undergraduates performed a modified exogenous cueing task, in which the location of a target was correctly or incorrectly cued by neutral, highly and mildly threatening pictures. Results indicate that at 100 ms picture presentation, HTA individuals more strongly engaged their attention with and showed impaired disengagement from highly threatening pictures than LTA individuals. In addition, HTA individuals showed a stronger tendency to attentional avoidance of threat at the 200 and 500 ms picture presentation. These data provide evidence for differential patterns of anxiety-related biases in attentive processing of threat at early versus later stages of information processing.     

A hierarchical model of operational anticipation windows in driving an automobile

Driving an automobile is an example of a goal-directed activity with high complexity in which different behavioral elements have to be integrated and brought into a sequential order. On the basis of the reafference principle and experimental results on temporal perception and cognitive control, we propose a hierarchical model of driving behavior, which can also be adapted to other goal-directed activities. Driving is conceived of as being controlled by anticipatory neuronal programs; if these programs are disrupted by unpredictable stimuli, which require an instantaneous reaction, behavioral control returns after completion of the reactive mode to the anticipatory mode of driving. In the model different levels of anticipation windows are distinguished which, however, are interconnected, in a bi-directional way: (a) Strategic level with a representation of the driving activity from the beginning to reaching the final goal; (b) Segmented tactical level with the sequence of necessary milestones to reach the goal; (c) Maneuver level where actions like passing another car or keeping a lane are controlled; (d) Short-term integration level of a few seconds which allows immediate anticipations; and (e) Synchronization level for sensorimotor control and complexity reduction within neuronal assemblies. A flow diagram schematically describes different driving situations stressing the anticipatory mode of control. In a pilot experiment with 20 subjects using a virtual driving situation in a car simulator predictions of the model could be verified, i.e., subjects showed a significant preference for the anticipatory mode of driving.     

Duration processing in children as determined by time reproduction: implications for a few seconds temporal window

From research carried out over recent years using different experimental paradigms, it has become apparent that central information processing is temporally segmented into sequential units of a few seconds. This segmentation presumably reflects a neuronal process of temporal integration (TI) which automatically binds successive events into temporal units. Support for such TI comes, for example, from studies on temporal reproduction where standards up to approximately 2-3 s are reproduced veridically. Using this paradigm of temporal reproduction, we investigated the effect of normal cognitive development of sensory modality and of the range of presented standards on TI. Sixty children aged 6-7, 9-10 and 13-14 years reproduced visual or auditory standard durations ranged from 1 to 5.5 s or from 1 to 3 s. The results showed that durations of approximately 2 s were reproduced correctly, whereas those longer than 2.5 s were under-reproduced in the three age groups. For standards shorter than 2 s substantial age-related differences were revealed: the youngest group displayed significant over-reproduction comparing to older subjects. These observations indicate that the upper limit for TI is a stable feature across the different age groups. Furthermore an age-related modulation within the temporal window of the operating TI seems to be linked to cognitive development.     

Do the Wechsler scales underestimate the difference between verbal and performance abilities in children with language–related disorders?

The present paper examines the validity of the Wechsler scales with children with language-related disorders, with whom the scales were not originally normed. The general question is whether we can take measures of IQ, normed with a normal sample, and then validly use them as indicators of the same constructs with samples significantly different from the normed sample. In previous papers it was pointed out that the pattern structurally simple > moderately complex > complex tests can be observed in their IQ profiles within both the Verbal scale and the Performance scale. In this paper, it is hypothesized that this scatter of scores leads to an underestimation of the global V-P IQ differences for children with language-related disorders because there are more structurally complex tests on the Performance scale than on the Verbal scale. To test this hypothesis, "purer" V-P IQ differences were calculated by comparing the scores on Verbal and Performance tests of equal structural complexity. WPPSI and WISC-R data from four groups of children were analyzed: language-impaired children (n = 128), reading-impaired children (n = 112), children from dyslexic families (n = 51), and normal children (n = 49). When the effect of the difference in structural complexity was controlled for, it was found that the distribution of the revised V-P IQ difference was significantly more toward the negative end of the spectrum than the traditional V-P IQ differences for language-impaired and reading-impaired children, and approaching a significant level for children from dyslexic families. As hypothesized, there were no significant differences between the two distributions of V-P IQ differences for normal children. Practical and theoretical implications are discussed.     

Functional neuroimaging of autistic disorders

Functional neuroimaging methods hold promise for elucidating the neurobiology of autistic disorders, yet they present difficult practical and scientific challenges when applied to these complex and heterogeneous syndromes. Single-state studies of brain metabolism and blood flow thus far have failed to yield consistent findings, but suggest considerable variability in regional patterns of cerebral synaptic activity. Patients with idiopathic autism are less likely to show abnormalities than are patients with comorbid illness or epilepsy. Activation studies have begun to suggest alterations in brain organization for language and cognition. Neurotransmitter studies using positron emission tomography (PET) suggest abnormalities of serotonergic and dopaminergic function. Studies using magnetic resonance spectroscopy (MRS) have begun to document metabolic deficits in the frontal cortex and cerebellum. A single study using magnetoencephalography suggests a high incidence of epileptiform activity in children with autistic regression. Research needs include well-controlled developmental studies, particularly of young subjects and relatively homogeneous subgroups, which balance scientific rigor with ethical constraints. Investigations of the serotonergic and dopaminergic systems, limbic-based memory and emotional systems, and the role of epileptiform activity in autism represent priorities for future research.     

Intra-individual variability in task performance after cognitive training is associated with long-term outcomes in children

The potential benefits and mechanistic effects of working memory training (WMT) in children are the subject of much research and debate. We show that after five weeks of school-based, adaptive WMT 6–9 year-old primary school children had greater activity in prefrontal and striatal brain regions, higher task accuracy, and reduced intra-individual variability in response times compared to controls. Using a sequential sampling decision model, we demonstrate that this reduction in intra-individual variability can be explained by changes to the evidence accumulation rates and thresholds. Critically, intra-individual variability is useful in quantifying the immediate impact of cognitive training interventions, being a better predictor of academic skills and well-being 6–12 months after the end of training than task accuracy. Taken together, our results suggest that attention control is the initial mechanism that leads to the long-run benefits from adaptive WMT. Selective and sustained attention abilities may serve as a scaffold for subsequent changes in higher cognitive processes, academic skills, and general well-being. Furthermore, these results highlight that the selection of outcome measures and the timing of the assessments play a crucial role in detecting training efficacy. Thus, evaluating intra-individual variability, during or directly after training could allow for the early tailoring of training interventions in terms of duration or content to maximise their impact.     

Family tree matters

The present paper investigates the form and structure of the psychoanalytic 'family tree', concentrating on the analysands of Sándor Ferenczi and Otto Rank, and their impact on contemporary psychoanalysis.     

Cognition,construction of knowledge,and teaching

The existence of objective knowledge and the possibility of communicating it by means of language have traditionally been taken for granted by educators. Recent developments in the philosophy of science and the historical study of scientific accomplishments have deprived these presuppositions of their former plausibility. Sooner or later, this must have an effect on the teaching of science. In this paper I am presenting a brief outline of an alternative theory of knowing that takes into account the thinking organism's cognitive isolation from reality. This orientation was proposed by Vico at the beginning of the 18th century, disregarded for two hundred years, and then propounded independently by Piaget as a developmentally grounded constructivist epistemology. The paper focuses specifically on the adaptive function of cognition, Piaget's scheme theory, the process of communication, and the subjective perspective on social interaction. In the concluding section it then suggests some of the consequences the shift of epistemological presuppositions might have for the practice of teaching.The only truly ubiquitous factor in cognitive developments — be it in the history of science or in the ontogeny of mind — are of a functional, not a structural kind.Piaget and Garcia, 1983, p. 38I am indebted to Jack Lochhead and John Clement for their helpful critical comments on the draft of this paper. The work that led to it was supported in part by NSF Grants to IBR. University of Georgia, and SRRI, University of Massachusetts.