Ethics issues in security hospitals

The term 'security hospital' is used for a variety of facilities including forensic hospitals and prison hospitals, which, because of their mission, the nature of their work, and the populations they serve-or because of the authority under which they operate-place the staff at considerable risk of ethical violations related to either clinical care or to forensic activities. The problem of divided loyalties is of special concern in security hospitals. Ethics principles particularly at risk are confidentiality and informed consent. Where there are cultural disparities between the staff and the patients, differences in background, socioeconomic class, education, and other types of diversity, cultural awareness is required and must be reflected in appropriate treatment and evaluation. To counteract the risks of ethical violations, a security hospital should create an ethical climate and develop means to anticipate, prevent, and deal with ethical violations. These might include detailed and specific policies and procedures, programs of orientation, education, consultation, and liaison as well as its own ethics committee.     

Win-shift and win-stay learning in the short-beaked echidna (<Emphasis Type="Italic">Tachyglossus aculeatus</Emphasis>)

Numerous previous investigators have explained species differences in spatial memory performance in terms of differences in foraging ecology. In three experiments we attempted to extend these findings by examining the extent to which the spatial memory performance of echidnas (or "spiny anteaters") can be understood in terms of the spatio-temporal distribution of their prey (ants and termites). This is a species and a foraging situation that have not been examined in this way before. Echidnas were better able to learn to avoid a previously rewarding location (to "win-shift") than to learn to return to a previously rewarding location (to "win-stay"), at short retention intervals, but were unable to learn either of these strategies at retention intervals of 90 min. The short retention interval results support the ecological hypothesis, but the long retention interval results do not. Electronic Publication     

Psychosocial Treatment Strategies in the MTA Study: Rationale, Methods, and Critical Issues in Design and Implementation

The Collaborative Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (ADHD), the MTA, is the first multisite, cooperative agreement treatment study of children, and the largest psychiatric/psychological treatment trial ever conducted by the National Institute of Mental Health. It examines the effectiveness of Medication vs. Psychosocial treatment vs. their combination for treatment of ADHD and compares these experimental arms to each other and to routine community care. In a parallel group design, 579 (male and female) ADHD children, aged 7–9 years, 11 months, were randomly assigned to one of the four experimental arms, and then received 14 months of prescribed treatment (or community care) with periodic reassessments. After delineating the theoretical and empirical rationales for Psychosocial treatment of ADHD, we describe the MTA's Psychosocial Treatment strategy applied to all children in two of the four experimental arms (Psychosocial treatment alone; Combined treatment). Psychosocial treatment consisted of three major components: a Parent Training component, a two-part School Intervention component, and a child treatment component anchored in an intensive Summer Treatment Program. Components were selected based on evidence of treatment efficacy and because they address comprehensive symptom targets, settings, comorbidities, and functional domains. We delineate key conceptual and logistical issues faced by clinical researchers in design and implementation of Psychosocial research with examples of how these issues were addressed in the MTA study.Deceased     

Family Processes and Treatment Outcome in the MTA: Negative/Ineffective Parenting Practices in Relation to Multimodal Treatment

To elucidate processes underlying therapeutic change in a large-scale randomized clinical trial, we examined whether alterations in self-reported parenting practices were associated with the effects of behavioral, medication, or combination treatments on teacher-reported outcomes (disruptive behavior, social skills, internalizing symptoms) in children with attention-deficit hyperactivity disorder (ADHD). Participants were 579 children with Combined-type ADHD, aged 7–9.9 years, in the Multimodal Treatment Study of Children with ADHD (MTA). We uncovered 2 second-order factors of parenting practices, entitled Positive Involvement and Negative/Ineffective Discipline. Although Positive Involvement was not associated with amelioration of the school-based outcome measures, reductions in Negative/Ineffective Discipline mediated improvement in children's social skills at school. For families showing the greatest reductions in Negative/Ineffective Discipline, effects of combined medication plus behavioral treatment were pronounced in relation to regular community care. Furthermore, only in combination treatment (and not in behavioral treatment alone) was decreased Negative/Ineffective Discipline associated with reduction in children's disruptive behavior at school. Here, children in families receiving combination treatment who showed the greatest reductions in Negative/Ineffective Discipline had teacher-reported disruptive behavior that was essentially normalized. Overall, the success of combination treatment for important school-related outcomes appears related to reductions in negative and ineffective parenting practices at home; we discuss problems in interpreting the temporal sequencing of such process-outcome linkages and the means by which multimodal treatment may be mediated by psychosocial processes related to parenting.     

Parenting and Family Stress Treatment Outcomes in Attention Deficit Hyperactivity Disorder (ADHD): An Empirical Analysis in the MTA Study

Parenting and family stress treatment outcomes in the MTA study were examined. Male and female (579), 7–9-year-old children with combined type Attention Deficit Hyperactivity Disorder (ADHD), were recruited at six sites around the United States and Canada, and randomly assigned to one of four groups: intensive, multi-faceted behavior therapy program alone (Beh); carefully titrated and monitored medication management strategy alone (MedMgt); a well-integrated combination of the two (Comb); or a community comparison group (CC). Treatment occurred over 14 months, and assessments were taken at baseline, 3, 9, and 14 months. Parenting behavior and family stress were assessed using parent-report and child-report inventories. Results showed that Beh alone, MedMgt alone, and Comb produced significantly greater decreases in a parent-rated measure of negative parenting, Negative/Ineffective Discipline, than did standard community treatment. The three MTA treatments did not differ significantly from each other on this domain. No differences were noted among the four groups on positive parenting or on family stress variables. Results are discussed in terms of the theoretical and empirically documented importance of negative parenting in the symptoms, comorbidities and long-term outcomes of ADHD.     

The Social Costs of Treatment Programs

The medicalization of deviance refers to the identification as diseases or illnesses of patterns of behavior that were previously considered in moral terms. Herbert Spencer viewed society as analogous to a living organism. A problem or disease in one part of the organism affects the entire organism. Early sociologists built on this idea and arrived at the conclusion that deviant behavior could be thought of as social disease and social pathology. The early social pathologists were concerned with crime, mental illness, drug abuse, and suicide. There is a tendency to treat such ailments in a hospital or clinical setting. The medicalization of deviance removes responsibility from the individual as well as from the society which continues to produce the problem. Treatment programs give the false impression that something worthwhile is being done about society's behavioral problems and turn the individuals treated back into the same social milieu in which the problem was incubated in the first place. The medicalization of deviance creates a vested-interest industry dependent upon the treatment of individuals. It has constructed a system of individualized microlevel treatment programs that can be beneficial on a limited basis for a few individuals and their families, but it tends to treat only the symptoms but not change the society of which they are but emanations.     

Low-frequency acoustic modulations generated by the high-frequency portion of the cochlea, noninvasively recorded from the scalp of mice (Mus musculus)

Vocalizations often contain low-frequency modulations of the envelope of a high-frequency sound. The high-frequency portion of the cochlear nerve of mice (Mus musculus) generates a robust phase-locked response to these low-frequency modulations, and it can be easily recorded from the surface of the scalp. The cochlea is most sensitive to envelope modulation frequencies of approximately 500 to 2000 Hz. These responses have detection thresholds that are approximately 10 dB more sensitive than auditory brainstem responses, and they are very sharply tuned. These measurements may provide a nontraumatic means of repeatedly assessing cochlear functions involved in sound localization and perception of vocalizations.     

Modality effects and the development of the word length effect in children

Two experiments investigated the development of the word length effect in children aged 4 to 10 years, comparing auditory and visual stimuli. The question addressed was whether word length effects emerged earlier with auditory presentation or visual presentation, or whether they emerged at the same age regardless of presentation modality. Results provided evidence that word length effects emerge earlier with visual than auditory presentation. The implication of our results is that with visual presentation, 4-year-olds engage in some form of verbalization strategy that involves obtaining phonological representations of picture names and mapping them on to articulatory output plans. This strategy is clearly verbal in nature, but is not necessarily characterised as cumulative verbal rehearsal.