Late Preterm Birth: A Review of Medical and Neuropsychological Childhood Outcomes

Late preterm (LP) birth (34 0/7 - 36 6/7 weeks?? gestation) accounts for nearly three-fourths of all preterm births, making this population a sizeable public health concern. The immature fetal development associated with LP delivery increases the risk of mortality and short-term medical complications. Which combination of maternal, fetal, or neonatal risk factors may be most critical has only recently begun to be addressed, and whether LP birth??s disruptive impact on brain development will exert adverse effects on neuropsychological functioning in childhood and adolescence has been understudied. Early data have shown a graded response, with LP children often functioning better than very preterm children but worse than term children, and with subtle intellectual and neuropsychological deficits in LP children compared with healthy children born at term gestational age. Further characterization of the neuropsychological profile is required and would be best accomplished through prospective longitudinal studies. Moreover, since moderate and LP births result in disparate medical and psychological outcomes, the common methodology of combining these participants into a single research cohort to assess risk and outcome should be reconsidered. The rapidly growing LP outcomes literature reinforces a critical principle: fetal development occurs along a dynamic maturational continuum from conception to birth, with each successive gestational day likely to improve overall outcome.     

Disgust-specific modulation of early attention processes

Although threatening images are known to attract and keep our attention, little is known about the existence of emotion-specific attention effects. In this study (N = 46), characteristics of an anticipated, disgust-specific effect were investigated by means of a covert orienting paradigm incorporating pictures that were either disgust-evoking, fear-evoking, happiness-evoking or neutral. Attention adhesion to these pictures was measured by the time necessary to identify a peripheral target, presented 100, 200, 500, or 800 ms after picture onset. Main results showed that reaction times were delayed for targets following the disgust-evoking pictures by 100 and 200 ms, suggesting that only these pictures temporarily grabbed hold of participants' attention. These delays were similar for ignore- and attend-instructions, and they were not affected by the participants' anxiety levels or disgust sensitivity. The disgust-specific influence on early attention processes thus appeared very robust, occurring in the majority of participants and without contribution of voluntary- and strategic-attention processes. In contrast, a smaller and less reliable effect of all emotional (arousing) pictures was present in the form of delayed responding in the 100 ms cue-target interval. This effect was more transitory and apparent only in participants with relatively high state-anxiety scores. Practical and theoretical consequences of these findings are discussed.     

The association between personality,attachment, psychological distress,church denomination and the god concept among a non-clinical sample

The association between personality, attachment, psychological distress, church denomination and the God concept was studied among a sample of 208 subjects from the normal population. Subjects were Christians, members of an Orthodox reformed church or the Pentecostal church. Negative feelings towards God were associated with a high level of harm avoidance, insecure attachment and a high level of psychological distress. Psychological distress mediated the association between personality and attachment variables and negative feelings towards God. Psychological distress and church denomination were the only two independent predictors of negative feelings towards God. Moreover, results showed that the Orthodox reformed church members hold a more negative concept of God than the Pentecostal church members do. Orthodox reformed church members see God in particular as a punitive judge, independent of personality, attachment and psychological distress, suggesting a large influence of religious culture on this particular type of God concept. Results are discussed from a psychotherapeutic point of view. Finally, several ethical issues regarding psychotherapy with religious clients are addressed.     

Counseling in Australia: Past,Present, and Future

The author describes the evolution of the counseling profession in Australia within the broader historic and sociocultural context. The process of professionalization is outlined, particularly over the past 15 years, and data on the demographic, professional, and practice characteristics of counselors are reviewed. Future professional directions and challenges are explored.     

Selective deficit in spatial location memory in extremely low birth weight children at age six: The PETIT Study

Spatial location memory has rarely been assessed in young children due to a scarcity of developmentally appropriate tests. This study sought to compare nonverbal learning and recall in children born extremely low birth weight (ELBW; <1000 g) and less than 33 gestational weeks (GW) with term-born children at early school age using a recently developed and adapted test. We administered a modification of the Hopkins Board to 210 children at age six; 84 born ELBW (35 born < 26 GW; 49 born 26–33 GW) and 126 term-born. Six measures were obtained: naming, trials-to-criterion, errors-to-criterion, delayed item recall, delayed location recall, and percent retention. After age correction, ELBW children had worse general cognition, item naming, delayed item recall, delayed location recall, and percent retention than term-born children. Delayed item recall and percent retention performances of ELBW children remained worse after correction for general cognition. ELBW groups (< 26 GW and 26–33 GW) groups performed worse than term-born children in naming and delayed item recall with chronological age as covariate. Those born before 26 GW, but not 26–33 GW, performed worse than term-born children in delayed location recall and percent retention. Differences remained significant after controlling for gender, maternal education, and delivery type. All three groups' performance declined from final learning trial to delayed location recall, with a decline greater for less than 26 GW than term-born children. Extreme prematurity (< 26 GW) and ELBW are significant risk factors for spatial location memory deficit. The modified Hopkins Board discriminated high-risk preterm and term-born children at early school age and appears to be a useful test to measure this rarely studied cognitive capacity.     

Executive functions in extremely low birth weight and late-preterm preschoolers: Effects on working memory and response inhibition

Executive function (EF) refers to fundamental capacities that underlie more complex cognition and have ecological relevance across the individual's lifespan. However, emerging executive functions have rarely been studied in young preterm children (age 3) whose critical final stages of fetal development are interrupted by their early birth. We administered four novel touch-screen computerized measures of working memory and inhibition to 369 participants born between 2004 and 2006 (52 Extremely Low Birth Weight [ELBW]; 196 late preterm; 121 term-born). ELBW performed worse than term-born on simple and complex working memory and inhibition tasks and had the highest percentage of incomplete performance on a continuous performance test. The latter finding indicates developmental immaturity and the ELBW group's most at-risk preterm status. Additionally, late-preterm participants performed worse compared with term-born on measures of complex working memory but did not differ from those term-born on response inhibition measures. These results are consistent with a recent literature that identifies often subtle but detectable neurocognitive deficits in late-preterm children. Our results support the development and standardization of computerized touch-screen measures to assess EF subcomponent abilities during the formative preschool period. Such measures may be useful to monitor the developmental trajectory of critical executive function abilities in preterm children, and their use is necessary for timely recognition of deficit and application of appropriate interventional strategies.     

The assessment of adolescents: preconceptions and realizations

The paper explores, in detail, the process of a single assessment as it unfolds session by session. It draws attention to the inevitability of the clinician's harbouring preconceptions of all kinds - especially when working with adolescents. It focuses on the difficulty of withstanding those preconceptions and allowing the patient's true anxieties, conscious and unconscious, to emerge. The process is a complex one requiring close attention to transference and countertransference manifestations, to the central significance of observation, to Bion's notion of the opacity of memory and desire. The case, that of a hypochondriacal 17-year-old young woman, highlights some main concerns and defences of the age group, for example, somatization, separation, fears of madness, issues of identity and, most fundamental of all, sexuality.     

Integration,unintegration, disintegration: an introduction

This introduction to the two papers that follow by Anne Alvarez and Edna O'Shaughnessy is a revised version of the introduction to the ACP Study Day in February 2005 on ‘Integration, Unintegration, Disintegration’, at which Alvarez and O'Shaughnessy had presented and which the author had chaired. The background to the debate is given in terms of how the ACP Study Day itself came about, and the central theme is highlighted in terms of the question of whether unintegration is conceived of as a normal stage of development or only a temporary state of mind in response to catastrophic anxieties. Brief clinical material from a case supervised by the author is discussed in order to elaborate this central question.