Children and Adolescents with Medically Unexplained Symptoms: A Systematic Review of the Literature

Abstract

Medically unexplained symptoms (MUS) in children and adolescents are confounding and concerning for patients, parents, and health care practitioners. Our goal was to review and summarize the literature for family therapists working with a diverse, challenging patient population coping with MUS. A search of multiple databases from 1994 to 2018 was conducted using MUS and related terms. The literature was then organized into subcategories based on its relevance to family therapists, particularly medical family therapists collaborating with primary care physicians. We conclude with a discussion about gaps in the literature and suggestions for clinical management.     

Patently controversial: markets,morals, and the President's proposal for embryonic stem cell research

This essay considers the implications of President George W. Bush's proposal for human embryonic stem cell research. Through the perspective of patent law, privacy, and informed consent, we elucidate the ongoing controversy about the moral standing of human embryonic stem cells and their derivatives and consider how the inconsistencies in the president's proposal will affect clinical practice and research.     

Pigeons' choices in situations of diminishing returns: fixed- versus progressive-ratio schedules.

In two different discrete-trial procedures, pigeons were faced with choices between fixed-ratio and progressive-ratio schedules. The latter schedules entail diminishing returns, a feature analogous to foraging situations in the wild. In the first condition (no reset), subjects chose between a progressive-ratio schedule that increased in increments of 20 throughout a session and a fixed-ratio schedule that was constant across blocks of sessions. The size of the fixed ratio was varied parametrically through an ascending and then a descending series. In the reset condition, the same fixed-ratio values were used, but each selection (and completion) of the fixed ratio reset the progressive-ratio schedule back to its minimal value. In the no-reset procedure, the pigeons tended to cease selecting the progressive ratio when it equaled or slightly exceeded the fixed-ratio value, whereas in reset, they chose the fixed ratio well in advance of that equality point. These results indicate sensitivity to molar as well as to molecular reinforcement rates, and those molar relationships are similar to predictions based on the marginal value theorem of optimal foraging theory (e.g., Charnov, 1976). However, although previous results with monkeys (Hineline & Sodetz, 1987) appeared to minimize responses per reinforcement, the present results corresponded more closely to predictions based on sums-of-reciprocals of distance from point of choice to each of the next four reinforcers. Results obtained by Hodos and Trumbule (1967) with chimpanzees in a similar procedure were intermediate between these two relationships. Variability of choices, as well as median choice points, differed between the reset and no-reset conditions.(ABSTRACT TRUNCATED AT 250 WORDS)     

Variable-ratio conditioning history produces high- and low-rate fixed-interval performance in rats

Four rats were exposed to an A-B-A-B series of 30 sessions each of variable-ratio 20 (A) and fixed-interval 30-s (B) schedules. Four other rats received 120 sessions of fixed-interval 30 s. The rats with a history of variable-ratio responding subsequently showed primarily high or low response-rate patterns on the fixed-interval schedule without evidence of classical scalloping (i.e., increased rates of responding throughout the interreinforcement interval), except infrequently in 1 rat. The rats exposed to only the fixed-interval 30-s schedule displayed the expected sequence of scalloping giving way to lower rate break-run or simply low-rate responding over time. This experiment shows that when naive rats are exposed to even a simple history of reinforcement (in this case, a variable-ratio 20), their subsequent fixed-interval performance is very different from comparable performance in naive rats, and might be said to be more similar to the responding of adult humans. The argument is made that care should be taken in comparing the fixed-interval performance of humans and nonhumans because humans have a complex history of reinforcement, whereas laboratory nonhumans are typically naive.     

Are the times changing? An analysis of sex-role prejudice

Sex bias was studied through evaluation of articles, in a technique modeled upon Goldberg's. Goldberg (1968) indicated that college women evaluated an article more positively when it was ascribed to a male rather than to a female author. The primary purpose of the present research was to examine a diverse sample, including subjects of both sexes and varying ages, and to determine whether sex-role attitudes have changed over time. Therefore, 64 students at the University of California, Santa Cruz, 64 students from San Jose State University, and 96 nonstudents from the San Francisco—Monterey Bay areas each evaluated six articles on several dimensions. Packets were counterbalanced for ascribed sex of author and sex of topic (male, female, or neutral). An analysis of variance yielded significant main effects for sex of subject and sex of topic. Further analyses yielded complex interactions which appeared to be primarily due to the responses of young nonstudents. The absence of an overall sex of author effect and the general pattern of data are interpreted in terms of the generalizability of research findings.Some of the results reported in this paper were presented in a symposium on sex-role research methodology at the annual meeting of the Western Psychological Association, Los Angeles, April 1976.     

The Other Accent Effect in Talker Recognition: Now You See It,Now You Don't

The existence of the Language Familiarity Effect (LFE), where talkers of a familiar language are easier to identify than talkers of an unfamiliar language, is well-documented and uncontroversial. However, a closely related phenomenon known as the Other Accent Effect (OAE), where accented talkers are more difficult to recognize, is less well understood. There are several possible explanations for why the OAE exists, but to date, little data exist to adjudicate differences between them. Here, we begin to address this issue by directly comparing listeners’ recognition of talkers who speak in different types of accents, and by examining both the LFE and OAE in the same set of listeners. Specifically, Canadian English listeners were tested on their ability to recognize talkers within four types of voice line-ups: Canadian English talkers, Australian English talkers, Mandarin-accented English talkers, and Mandarin talkers. We predicted that the OAE would be present for talkers of Mandarin-accented English but not for talkers of Australian English—which is precisely what we observed. We also observed a disconnect between listeners’ confidence and performance across different types of accents; that is, listeners performed equally poorly with Mandarin and Mandarin-accented talkers, but they were more confident with their performance with the latter group of talkers. The present findings set the stage for further investigation into the nature of the OAE by exploring a range of potential explanations for the effect, and introducing important implications for forensic scientists’ evaluation of ear witness testimony.     

Dancing is belonging! How social networks mediate the effect of a dance intervention on students' sense of belonging to their classroom

What does it take to feel you belong? Using a sample of 606 students in 30 classrooms, with 15 classrooms participating in a school‐based dance intervention, we examined intrapsychic and extrapsychic sources of social belonging using social network analysis. Whereas outdegree (the number of outgoing liking nominations to classmates) served as a proxy variable for students' active acceptance of others, indegree (the number of ingoing liking nominations from other peers) served as a proxy variable for the passive acceptance by others. Both measures should account for changes in students' sense of belonging to their classroom. Multilevel longitudinal mediation analyses supported our predictions—increased belonging related to increasing acceptance by others and of others, which were experienced by students participating in the dance intervention for a year (vs. a non‐treated control group). We discuss our findings within the current debate on the use of distal variables to explain intrapsychic constructs.     

The analytic situation as a dynamic field. 1969

This paper discusses the consequences of the importance that recent ³ papers assign to the countertransference. When the latter acquires a theoretical and technical value equal to that of the transference, the analytic situation is configured as a dynamic bi‐personal field, and the phenomena occurring in it need to be formulated in bi‐personal terms. First, the field of the analytic situation is described, in its spatial, temporal and functional structure, and its triangular character (the present–absent third party in the bi‐personal field) is underlined. Then, the ambiguity of this field is emphasized, with special weight given to its bodily aspect (the bodily experiences of the analyst and the patient being particularly revealing of the unconscious situation in the field). The different dynamic structures or lines of orientation of the field are examined: the analytic contract, the configuration of the manifest material, the unconscious configuration – the unconscious bi‐personal phantasy manifesting itself in an interpretable point of urgency – that produces the structure of the field and its modifications. The authors describe the characteristics of this unconscious couple phantasy: its mobility and lack of definition, the importance of the phenomena of projective and introjective identification in its structuring. The authors go on to study the functioning of this field, which oscillates between mobilisation and stagnation, integration and splitting. Special reference is made to the concept of the split off unconscious ‘bastion’ as an extremely important technical problem. The analyst’s work is described as allowing oneself to be partially involved in the transference–countertransference micro‐neurosis or micro‐psychosis, and interpretation as a means of simultaneous recovery of parts of the analyst and the patient involved in the field. Finally, the authors describe the bi‐personal aspect of the act of insight that we experience in the analytic process.