Models of the relationship between genetic counselor and client

Three alternative models of the relationship between genetic counselors and clients are typified by the paternalistic professional, the expert consultant, and the autonomous client. Kant's principle of autonomy stipulates that the agent with rational will is to be treated as an end in itself rather than merely as a means to an end. Mutual respect between two such autonomous agents, in our case a genetic counselor and a client, will dictate elements of the clinical encounter.     

Towards a spiritual psychology: The synthesis of the desert fathers

The author presents a model of spiritual enlightenment based on an analysis of the aphorisms and experiences of the 3rd, 4th, and 5th century monastics of the deserts of Egypt contained in the standard 18th century Greek Orthodox compilation of their writings. It is argued that the attainment of a hierarchy of four basic virtues, humility, obedience, repentance, and love, incorporated into the religious system of these early Christian contemplatives exemplifies a sophisticated knowledge of contemporary dynamic and social psychological phenomena. The author identifies three steps in the process of enlightenment proffered by this system, beginning with the practical spiritual life, in which the specific control and understanding of dynamic and social psychological principles come into play; moving on to an intermediate level of action based on natural knowledge, as it is derived from psychological self-understanding; and culminating in a level of personal self-intergration and self-realization that is mystical in nature. Thenovus homo as understood in the Christian West is contrasted with the enlightened person as he emerges from this interactive hierarchy of virtues and levels of self-knowledge in the system of the desert Fathers. The paper is written with a heuristic tone and suggests that further attention be directed toward the interaction between psychological principles and mystical notions in traditional Eastern Christian literature.This paper was originally presented by the author at the invitation of the Theological Institute of Lund University, Lund, Sweden, in the autumn of 1987.     

Classification and validation of family climate subtypes in Kibbutz fathers of disabled and nondisabled children

The aim of the study was to investigate the impact of disabled children on their fathers. Perceptions of family climate, sense of coherence, and satisfaction from family life were measured among 66 fathers of disabled children and among 74 fathers with nondisabled children in an Israeli kibbutz. The fathers of disabled children showed lower sense of coherence, derived less satisfaction from family life, and viewed their families as less encouraging of personal growth among family members. Four subtypes of family climate patterns, perceived by fathers of disabled children, were identified by cluster analysis and validated by the sense of coherence and global family satisfaction measures. Cluster analysis for the fathers of nondisabled children replicated the subtypes identified. The four subtypes were conceptualized as families with a (a) personal growth orientation, (b) conflict orientation, (c) conflict avoidance orientation, and (d) recreation avoidance orientation. Significant differences were found between the subtypes with regard to the family climate variables and satisfaction and coherence measures. Results demonstrated that different patterns of family climate characterized the two groups of fathers: In almost every cluster the measures of personal growth were lower for the fathers of disabled children.The authors would like to acknowledge the editorial assistance of Dee M. Bargteil.Special Education, Kibbutzim Movement, Tel Aviv, Israel 61400.     

The effects of background illumination and stimulant medication on smooth pursuit eye movements of hyperactive children

Problems with visual information processing have been reported in children with the diagnosis of attention deficit disorder with hyperactivity (ADD H), and deficits in oculomotor control have been posited as an important factor in this phenomenon. To assess aspects of oculomotor performance, smooth pursuit eye movements (PEMs) were recorded electrooculographically in 20 ADD H and 20 age-matched control children and computer-analyzed for discrete (velocity arrests) and global (root mean square error) disruptions. The effects of stimulant medication (methylphenidate), together with manipulations designed to influence behavioral (attention) and physiological (cerebellar) processes involved in PEM performance, were examined. The tracking patterns of nonmedicated ADD H children contained significantly more discrete aberrations on baseline conditions. Although no single experimental manipulation significantly improved tracking performance in ADD H children, combining all experimental conditions did normalize PEMs in these subjects. Slight improvements in PEM performance in association with medication correlated positively with does of madication of with medication-related improvments of behavior. In light of these data, arguments are presented in supported of (a) hyporousal as a contributing factor underlying oculomotor difficulties in ADD H children and (b) subcortical involbment in PEM dysfunction.This research was funded in part by grants from The Hospital for Sick Children Foundation and the Ontario Mental Health Foundation (RTP). The authors thank Susan Anthony, Dr. Pamela M. Cooper, Stella Cowley, Dr. Kathy Margittai, and Ralph Nevins for technical assistance, Martin Gillett for computer programming, Dr. Phil Firestone and the staff of the University of Ottawa Child Study Centre, and Dr. B. Lena of the Family and Child Unit, Ottawa General Hospital, for subject referral.     

Reading,spelling, and vigilance in attention deficit and conduct disorder

A group of 51 male children, average age 9.1 years, presenting at a child psychiatric clinic because of attention and conduct problems were investigated for reading and phonetic spelling ability, vigilance, and intellectual level. Each child was given a DSM- III diagnosis prior to being tested. The Boder Test of Reading and Spelling patterns was used to obtain scores for reading age, number of syllables read correctly in the word list at the child's reading level, and number of phonetically correct syllables spelled in the known and unknown word lists, at and just above the child's reading level. A factor analysis with varimax rotation produced two significant factors, a Reading factor with high loadings for verbal and reading scores, aand a second Vigilance factor. Phonetic spelling ability loaded separately from reading into the Vigilance factor. The Vigilance factor was significantly related to the diagnosis of moderate and severe attention deficit disorder with hyperactivity (ADDH). The correlation of short- term working memory with vigilance in moderate to severe ADDH children is discussed.Fundling assistance was provided by the New South Wales Institute of Psychiatry.     

Social networks and the treatment of schizophrenia

The importance of social network relations to the clinical status of schizophrenic patients is documented. The author notes that recent innovative clinical treatment programs incorporate social network concepts, although not always using such theoretical concepts. The importance of social network concepts in treatment and rehabilitation is noted.     

Carson Strong's “positive killing and the irreversibly unconscious patient”: A commentary

There is general agreement that death of the entire brain results in death of the person, and that such a condition can exist in a body which is still technically “alive.”1,2 Dr. Strong additionally contends that in cases of irreversible coma, since cognitive abilities characteristic of the person are no longer manifest and cannot be expected to reappear, such an individual no longer has the “right to life” and somatic death can be initiated by “positive killing.” This, the author claims, can be considered a logical and morally acceptable extension of the conceptual framework now in force for dealing with cases of isolated brain death.     

A multidimensional assessment of parent-identified behavior problem toddlers

Sixty-eight 2-and 3-year-olds (46 parent-referred, 22 controls) participating in an identification, assessment, and follow-up study of hyperactivity and related behavior problems were evaluated on parent-report, observational, and cognitive measures. Referred youngsters were described by both parents as more active, inattentive, difficult to discipline, and aggressive with peers than were controls. Mothers of referred children also reported a more difficult infancy period. Laboratory assessments confirmed parental reports of current problems. Referred children shifted activities more during free play, were more active and inattentive during structured tasks, and made more impulsive responses on a delay task than did controls. Discriminant function analysis indicated that parental ratings of activity paired with laboratory measures of sustained attention and impulsivity correctly classified 88% of the sample. These data suggest that the core symptoms of hyperactivity can be identified in very young children, although their prognostic significance remains to be determined.This research was supported by Grant No. R01 MH 32735 from the National Institute of Mental Health to the first author. Thanks are due to the parents and children who participated so enthusiastically in this study. The dedication of Patricia Cluss is gratefully acknowledged. Mady Fingeret, Frank McKee, Jenny Palermo, Susan Riley, Elizabeth Schaughency, Sheree Thomas, and Russell Walters are also thanked for their help in data collection.     

A practical method for screening psychiatric disorder in children with speech and language disorders

Children with speech and language disorders have been found to have a prevalence rate of psychiatric disorder of 50%. The authors sought to develop an efficient screening procedure to distinguish such children who have psychiatric disorder and those who do not. Cutoff scores for easily administered parent and teacher behavior rating questionnaires were investigated in a population of 256 children with speech and language disorders and known presence or absence of psychiatric disorder. It was learned that when the questionnaires are used together, a cutoff score of 31 or greater on either questionnaire has a positive predictive value of 74.1 % and a negative predictive value of 76.1%. This screening method shows promise in assisting speech pathologists in comprehensive evaluation and treatment planning for children with speech and language disorders.