Psychological Treatments for Mental Disorders in Children and Adolescents: A Review of the Evidence of Leading International Organizations

In recent decades, the evidence on psychological treatments for children and adolescents has increased considerably. Several organizations have proposed different criteria to evaluate the evidence of psychological treatment in this age group. The aim of this study was to analyze evidence-based treatments drawn from RCTs, reviews, meta-analyses, guides and lists provided by four leading international organizations. The institutions reviewed were the National Institute for Health and Care Excellence, the Society of Clinical Child and Adolescent Psychology (Division 53) of the American Psychological Association, Cochrane Collaboration and the Australian Psychological Society in relation to mental disorders in children and adolescents. A total of 137 treatments were analyzed for 17 mental disorders and compared to determine the level of agreement among the organizations. The results indicate that, in most cases, there is little agreement among organizations and that there are several discrepancies within certain disorders. These results require reflection on the meaning attributed to evidence-based treatments with regard to psychological treatments in children and adolescents. The possible reasons for these differences could be explained by a combination of different issues: the procedures or committees may be biased, different studies were reviewed, different criteria are used by the organizations or the reviews of existing evidence were conducted in different time periods.     

Extended functionalism,radical enactivism,and the autopoietic theory of cognition: prospects for a full revolution in cognitive science

Recently, Michael Wheeler (2017) has argued that despite its sometimes revolutionary rhetoric, the so called 4E (embodied-embedded-enacted-extended) cognitive movement, even in the guise of ‘radical’ enactivism (REC), cannot achieve a full revolution in cognitive science. A full revolution would require the rejection of two essential tenets of traditional cognitive science, namely internalism and representationalism. Whilst REC might secure antirepresentationalism, it cannot do the same, so Wheeler argues, with externalism. In this paper, expanding on Wheeler’s analysis (2017), we argue that what compromises REC’s externalism is the persistence of cognitively relevant asymmetries between its purported cognitive systems and the environment. Complementarily, we argue that an antirepresentationalist ancestor of enactivism, the autopoietic theory of cognition, is able to deliver and secure externalism, thus offering the explosive combination (i.e., antirepresentationalism plus externalism) that Wheeler claims us needed for a revolution in cognitive science.     

“The Notion of Neutrality in Clinical Ethics Consultation”

Clinical ethics consultation (CEC), as an activity that may be provided by clinical ethics committees and consultants, is nowadays a well-established practice in North America. Although it has been increasingly implemented in Europe and elsewhere, no agreement can be found among scholars and practitioners on the appropriate role or approach the consultant should play when ethically problematic cases involving conflicts and uncertainties come up. In particular, there is no consensus on the acceptability of consultants making recommendations, offering moral advice upon request, and expressing personal opinions. We translate these issues into the question of whether the consultant should be neutral when performing an ethics consultation. We argue that the notion of neutrality 1) functions as a hermeneutical key to review the history of CEC as a whole; 2) may be enlightened by a precise assessment of the nature and goals of CEC; 3) refers to the normative dimension of CEC. Here, we distinguish four different meanings of neutrality: a neutral stance toward the parties involved in clinical decision making, toward the arguments offered to frame the discussion, toward the values and norms involved in the case, and toward the outcome of decision making, that is to say the final decision and action that will be implemented. Lastly, we suggest a non-authoritarian way to intend the term “recommendation” in the context of clinical ethics consultation.     

Communication of Genetic Risk Information to Daughters in Families with Fragile X Syndrome: The Parent’s Perspective

Parental approaches to communicating information about genetic disorders to their children may be an important determinant in how the children manage stress as well as their adjustment and adaptation to that information. We explored communication patterns through structured interviews with 46 parents of daughters who learned about their genetic risk status as minors. Three different levels of knowledge about fragile X syndrome were explored: 1) informing that it has been diagnosed in the family and is an inherited disorder, 2) informing about the possibility of a daughter being a carrier, and 3) if testing had been done, informing the daughter of her actual carrier status. Additionally, parental perceptions of their daughter’s understanding of the information were explored along with frequency of discussions. We found that communication about genetic risk was initiated by the parents. Five disclosure patterns were identified with variations in style, content, and frequency of communication related to the information that was being disclosed. Aspects of resilient communication were present for all levels of disclosure; however, as the information became more personally relevant for the daughter such as disclosure about the possibility of “being a carrier” for fragile X syndrome and there was uncertainty regarding potential outcomes, the conversations included fewer resilient characteristics. Uncertainty about what and how to present information may negatively affect a parent’s ability to include elements of resilient communication when disclosing genetic risk information.     

Loss of emotional insight in behavioral variant frontotemporal dementia or "frontal anosodiaphoria"

Loss of insight is a prominent clinical manifestation of behavioral variant frontotemporal dementia (bvFTD), but its characteristics are poorly understood. Twelve bvFTD patients were compared with 12 Alzheimer’s disease (AD) patients on a structured insight interview of cognitive insight (awareness of having a disorder) and emotional insight (concern over having a disorder). Compared to the AD patients, the bvFTD patients were less aware and less concerned about their disorder, and they had less appreciation of its effects on themselves and on others. After corrective feedback (“updating”), the bvFTD patients were just as aware of their disorder as the AD patients but remained unconcerned and unappreciative of its effects. These findings suggest that lack of insight in bvFTD is not due to “anosognosia,” or impaired cognitive and executive awareness of disease, but to “frontal anosodiaphoria,” or lack of emotional concern over having bvFTD and its impact on themselves and others.     

Prevalence and associated factors with body image dissatisfaction among adults in southern Brazil: A population-based study

We investigated the prevalence of body image dissatisfaction (BID) and associated factors in Florianopolis, Brazil. BID was analyzed in a sample (N = 1720) of adults through the Figure Rating Scale. The independent variables were sociodemographic factors, health behaviors, and morbidities. A multinomial logistic regression analysis was used. More men (14.2%) than women (6.1%) presented BID by being lighter than ideal (LI). Conversely, more women (66.6%) than men (46.3%) showed BID by being heavier than ideal (HI). BID by being HI was higher among older women, those with high BMI and those with a partner. In men, lower BMI and the presence of common mental disorders were associated with BID due to being LI. Advanced ages, alcohol abuse, physical inactivity, and obesity were associated with BID due to being HI. We must consider different public health interventions for men and women to reduce BID in Brazilian adults.