Valuing life and evaluating suffering in infants with life-limiting illness

Theoretical Medicine and Bioethics - In this paper, we explore three separate questions that are relevant to assessing the prudential value of life in infants with severe life-limiting illness....     

Understanding of literal truth, ironic criticism, and deceptive praise following childhood head injury.

Children with closed head injury (CHI) have semantic-pragmatic language problems that include difficulty in understanding and producing both literal and nonliteral statements. For example, they are relatively insensitive to some of the social messages in nonstandard communication as well as to words that code distinctions among mental states. This suggests that they may have difficulty with comprehension tasks involving first- and second-order intentionality, such as those involved in understanding irony and deception. We studied how 6- to 15-year-old children, typically developing or with CHI, interpret scenarios involving literal truth, ironic criticism, and deceptive praise. Children with severe CHI had overall poorer mastery of the task. Even mild CHI impaired the ability to understand the intentionality underlying deceptive praise. CHI, especially biologically significant CHI, appears to place children at risk for failure to understand language as externalized thought.     

The Darlington Family Assessment Sytem: clinical guidelines for practitioners

The Darlington Family Assessment System (DFAS) consists of a framework of widely accepted concepts, a semi-structured family interview and rating scale, and a detailed account of how to use the system in clinical practice. The model views health issues within a family life-cycle (developmental) framework. It assesses problems at four systemic levels: the child perspective, the parental perspective, the parent-child perspective, and the whole family perspective. The semi-structured interview is designed to see how family members perceive problems and to map out other possible problems, and is a useful basic training tool. Empirical work suggests that the framework of key concepts and the rating scale offer a powerful method for describing and differentiating families. There is evidence that the model is useful as a training method for health professionals undergoing basic training. Detailed clinical guidelines have also been developed, to show how the model can be applied in practice. The advantage of the model is that it can be used with a variety of therapeutic approaches, and to inform choices about which interventions are likely to be successful or not.     

The paradox(es) of pitying and fearing fictions

The acknowledged paradox in our emotional response to fictional characters and events is that the very beliefs required by a cognitive account of the emotions are excluded by knowledge that the context is fictional. Various proposed solutions have failed to reconcile cognitivism with respect to the emotions with the facts of that response. Those offered include denying cognitivism by excluding the belief on the emotions, denying genuine emotional response in these contexts, or advocating either fictional realism or irrationalism in such response. By specifically examining pity and fear this paper tries to reconcile genuine emotional response to fictional characters and events with a unified cognitive account of the emotions by arguing that instead of excluding belief the existential condition on the beliefs in an emotion can be lifted by the invitation to imagine. At the same time it shows that the richness of that response need not be denied and throws some light on further related paradoxes (for instance by indicating why not all emotions are rationally possible in fictive contexts and that although we can pity fictions we cannot rationally fear them). Then by explaining why, unlike in ordinary contexts we do not act on our emotions in fictive ones, it differentiates the reasons for passivity in fictional and in historical circumstances.     

Direct and Indirect Measures of Social Perception,Behavior, and Emotional Functioning in Children with Asperger’s Disorder,Nonverbal Learning Disability,or ADHD

Understanding social interactions is crucial for development of social competence. The present study was one of the first to utilize direct and indirect measures of social perception to explore possible differences among children with nonverbal learning disability (NLD), Asperger’s Syndrome (AS), Attention Deficit Hyperactivity Disorder-Combined (ADHD-C), Attention Deficit Hyperactivity Disorder-Predominately Inattentive (ADHD-PI), and controls (N = 342). Multiple informants provided ratings of the child’s behavioral and social functioning. Results indicated that the NLD and AS groups experienced the most difficulty understanding emotional and nonverbal cues on the direct measure. In addition, children with AS or NLD showed significant signs of sadness and social withdrawal compared to the other groups. Attentional skills, while related to social perception, did not predict social perception difficulties to the same degree as number of AS symptoms.