Reengagement With Education: A Multidisciplinary Home-School-Clinic Approach Developed in Australia for School-Refusing Youth

School refusal (SR) can result in decreased academic achievement, impaired social connections, and family stress. Current interventions for SR include behavioral and cognitive-behavioral treatments that are not always effective. Incorporating multidisciplinary work that includes therapeutic and educational interventions may enhance outcomes for youth displaying SR. The In2School program fosters a working partnership between mental health clinicians and teachers. It was designed to meet the needs of young people missing more than 50% of school in the previous 6 weeks due to mental health disorders, including anxiety or depression. This paper reports on an action research study in which the In2School program was piloted. Over a 14-week period, therapeutic and educational interventions were integrated into the learning environment via a transitional classroom to support youths’ return to school. Outcomes of this program are reported for the first cohort of 7 youth. Of these youth, 6 returned to mainstream schooling with attendance levels being maintained for 6 months after completing the intervention. Progress was observed in mental health recovery, quality of life reports, increased social interactions with peers, and positive experiences at school. The preliminary results presented in this paper suggest that a multidisciplinary, home-school-clinic intervention holds promise for helping school-refusing youth to return to school.     

Neuroimaging and disorders of consciousness: envisioning an ethical research agenda

The application of neuroimaging technology to the study of the injured brain has transformed how neuroscientists understand disorders of consciousness, such as the vegetative and minimally conscious states, and deepened our understanding of mechanisms of recovery. This scientific progress, and its potential clinical translation, provides an opportunity for ethical reflection. It was against this scientific backdrop that we convened a conference of leading investigators in neuroimaging, disorders of consciousness and neuroethics. Our goal was to develop an ethical frame to move these investigative techniques into mature clinical tools. This paper presents the recommendations and analysis of a Working Meeting on Ethics, Neuroimaging and Limited States of Consciousness held at Stanford University during June 2007. It represents an interdisciplinary approach to the challenges posed by the emerging use of neuroimaging technologies to describe and characterize disorders of consciousness.     

Employing multiple theories and evoking new ideas: the use of clinical material

In this paper, I wish to illustrate how working with a patient who had a certain kind of narcissistic difficulty led me to develop particular clinical strategies to facilitate the development of a sturdier sense of self, greater affect tolerance and modulation, the diminution of harshness of her superego, and the ownership of projected parts of herself, and to decrease paranoid ideation. I call upon concepts from various theoretical schools of psychoanalysis to make sense of the dynamic intricacies of the patient's psychological organization as they revealed themselves in the analytic process. These conceptualizations of the patient's difficulties and of clinical interventions to address them result in a hybrid theory of both theory and technique. What transpired in the clinical work also led me to propose an additional way to understand this kind of patient's difficulties with accepting interpretations or any view that differed from the patient's subjectivity. I am proposing that 'otherness' itself, rather than only specific conflictual aspects of the self, is disowned. It is the analyst's empathic stance toward all that is repudiated--the specific disowned aspects of the self and 'otherness' itself--along with empathy for the patient's conscious state that will enable reinternalization and ultimately healing.     

Maternal speech style with prelinguistic twin infants

The mother–infant communicative speech of a group of mothers of 4‐month‐old first‐born twin infants was compared to the speech of a group of mothers of first‐born singleton infants. Maternal groups were matched on age, education level, mother–infant attachment status and infant gender, and maternal depression was assessed as a control variable. Maternal speech was coded for focus, content, complexity and syntax of mothers' utterances. The findings of earlier studies with toddler age twins, that maternal speech style was more directive and less infant‐focused, were replicated in this prelinguistic period of infancy. Compared to mothers of singletons, mothers of twins used less infant‐focused speech, were less responsive to their infants' cues, and attributed less agency to their infants. Mothers of twins also used fewer questions and requests but did not differ from mothers of singletons in their use of negatives and imperatives. These early differences in the language learning environments of twin and singleton infants may be due to the reduced opportunities that mothers of twins have to establish dyadic communicative routines with their infants and to familiarize themselves with their infants as interactive partners, and may have implications for the early language development of twins. Copyright © 2002 John Wiley & Sons, Ltd.     

Group Pacing: A Developmental Eclectic Approach to Group Work

The authors examine a new approach to conducting group work, which is referred to as “developmental eclecticism.” Using Loevinger's (1976) theory of ego development as a guiding force in their counseling practice, the authors present a discussion that reflects various strategies implemented in working with a group of adults in a community mental health center setting.     

“Pretend you didn't know”: Preschoolers' talk about mental states in pretend play

Fifty preschoolers (mean age = 47 months; SD = 5 months) were recruited from local inner-city nurseries to take part in a study of early friendships and the development of social understanding. Friendship pairs (10 boy-boy pairs; 10 girl-girl pairs and 5 boy-girl pairs) were filmed playing together for 20 minutes in a quiet room supplied with toys and dressing-up materials. The videos were then transcribed and coded for mental-state talk and pretend play. The children were also given a battery of tests tapping theory-of-mind skills and verbal ability. The results indicated a strong association between children's engagement in pretend play, and the frequency and nature of mental-state talk. This association is discussed in relation to (1) effects of context, (2) individual differences in children's understanding of mind and verbal ability, and (3) the social nature of pretend play.     

Stimulus and response contributions to the children's reaction-time repetition effect

Adults and 8-, 10-, 12-, and 14-year olds completed a serial reaction-time task with two stimuli mapped to each of two responses and 100-, 500-, and 1000-msec response-stimulus intervals (RSIs). Trials were classified as (1) identical (same stimulus and same response on two consecutive trials), (2) response equivalent (different stimulus but same response on two consecutive trials), or (3) different (different stimulus and different response on two consecutive trials). Identical and different trials were compared as a general indication of repetition effects. Response-equivalent minus identical reaction time identified stimulus contributions, and different minus response-equivalent reaction time identified response contributions. Adults received a repetition advantage at all RSIs and children received a repetition advantage at 500- and 1000- but not 100-msec RSIs. Stimulus contributions accounted for the repetition effect for both adults and children. At the 500- and 1000-msec RSIs, both the overall repetition effect and stimulus contribution were positive and decreased in magnitude as age increased. The response contribution was independent of RSI and was negative for 8- and 10-year-olds and near zero or positive for older performers. At the longer RSIs, positive stimulus contributions were sufficient to overcome the negative response contributions present for younger children.