The Role for Occupational Therapists in Community Mobility Training for People With Autism Spectrum Disorders

Symptoms and behaviors of Autism Spectrum Disorders can challenge community mobility, thus hindering independence and participation in occupation. Community mobility, also called travel training, helps people make journeys safely using public transportation, enabling engagement in activities/services otherwise unavailable. Yet, few articles have been written about this topic for people with Autism Spectrum Disorders. The purpose of the authors in this article is to: (1) explain the need for travel training with people diagnosed with Autism Spectrum Disorders; (2) describe specific travel training assessments; (3) review literature on travel training programs; and (4) define a role for occupational therapy in travel training with individuals diagnosed with Autism Spectrum Disorders.     

Commentary on Paper by Ellen F. Fries

In Perchance to Sleep: Minding the Unworded Body in Psychoanalysis, Ellen F. Fries masterfully articulates the complexities of right-brain to right-brain, body-to-body interactions between herself and her patient. Her work highlights the dominance of the nonverbal implicit self over the verbal, explicit self and provides an excellent example of clinical work in which she thoughtfully attends to the unspoken, bodily based communication that takes place within the therapeutic dyad. In this discussion, I offer perspectives from Sensorimotor Psychotherapy on the impact of early attachment on the procedural organization of action sequences that reflect and sustain the implicit self, and embody unconscious relational expectations. The following topics are addressed: (a) Physical actions that provide avenues of exploration into the implicit self, especially actions such as reaching out, making eye contact, or maintaining an upright posture that are abandoned or distorted when they are ineffective in eliciting the desired response from attachment figures; (b) Body-oriented interventions that target the involuntary physical spasms that Fries' patient experiences, which are associated with unresolved physiological arousal originally stimulated in the face of trauma; and (c) The nonverbal manifestation and negotiation of enactments that emerge from the body-to-body dialogue between the implicit selves of patient and therapist.     

Narcissism in the modern world

Narcissism has been around since the time of Ovid more than 2000?years ago and the concept has long been a source of study, intrigue, fascination and literature both within and beyond the psychoanalytic community. While Narcissistic Personality Disorder remains a severe and fairly rare clinically diagnosed condition, sub-clinical narcissism or narcissistic traits have reached epidemic proportions with serious consequences. Ever increasing levels of greed, self-obsession, superficial relationships, arrogance and vanity are everywhere apparent and not making us any happier, with common mental health problems on the increase, especially among the young. Seemingly irreversible alterations to family life, technological development – including social media, attitudes to death and dying and celebrity worship, all feature in the rise of our narcissistic society and are interconnected trends. Group greed and grandiosity, as in the world of banking, have led to wide-scale corruption and cover-ups leaving us vulnerable and unable to place our trust in many organisations. Perhaps most sinister of all is our attitude to the planet that supports us, as we play a part in the destruction of much of the environment and many of the species that share the earth with us. Looking at the literature of narcissism, the aim of this paper is to consider ways in which cultural changes have brought about this huge rise in both individual and group egotism. We are seeing many more clients high on the narcissistic spectrum but consideration will be given to the narcissism of the therapist and the impact of the therapist’s narcissism on the client. We live in difficult times and cannot step outside our culture but there are ways of countering our narcissism and helping our clients to do the same. Having compassion for one’s self and recognising how ordinary we really are make for a good start.     

Breaching Confidentiality to Protect the Public: Evolving Standards of Medical Confidentiality for Military Detainees

Confidentiality is a core value in medicine and public health yet, like other core values, it is not absolute. Medical ethics has typically allowed for breaches of confidentiality when there is a credible threat of significant harm to an identifiable third party. Medical ethics has been less explicit in spelling out criteria for allowing breaches of confidentiality to protect populations, instead tending to defer these decisions to the law. But recently, issues in military detention settings have raised the profile of decisions to breach medical confidentiality in efforts to protect the broader population. National and international ethics documents say little about the confidentiality of detainee medical records. But initial decisions to use detainee medical records to help craft coercive interrogations led to widespread condemnation, and might have contributed to detainee health problems, such as a large number of suicide attempts several of which have been successful. More recent military guidance seems to reflect lessons learned from these problems and does more to protect detainee records. For the public health system, this experience is a reminder of the importance of confidentiality in creating trustworthy, and effective, means to protect the public's health.     

How Are Personality Judgments Made? A Cognitive Model of Reference Group Effects,Personality Scale Responses,and Behavioral Reactions

This article suggests that personality judgments are wholly relative, being the outcome of a comparison of a given individual to a reference group of others. The underlying comparison processes are the same as those used to judge psychophysical stimuli (as outlined by range frequency theory and decision by sampling accounts). Five experimental studies show that the same person's personality is rated differently depending on how his or her behavior (a) ranks within a reference group and (b) falls within the overall range of behavior shown by other reference group members. Results were invariant across stimulus type and response options (7-point Likert scale, 990-point allocation task, or dichotomous choice). Simulated occupational scenarios led participants to give different-sized bonuses and employ different people as a function of context. Future research should note that personality judgments (as in self-report personality scales) only represent perceived standing relative to others or alternatively should measure personality through behavior or biological reactivity. Personality judgments cannot be used to compare different populations when the population participants have different reference groups (as in cross-cultural research).     

Proximate and ultimate causes of punishment and strong reciprocity

While admirable, Guala's discussion of reciprocity suffers from a confusion between proximate causes (psychological mechanisms triggering behaviour) and ultimate causes (evolved function of those psychological mechanisms). Because much work on "strong reciprocity" commits this error, I clarify the difference between proximate and ultimate causes of cooperation and punishment. I also caution against hasty rejections of "wide readings" of experimental evidence.     

Bias in the Reporting of Family History: Implications for Clinical Care

Family history of cancer is critical for identifying and managing patients at risk for cancer. However, the quality of family history data is dependent on the accuracy of patient self reporting. Therefore, the validity of family history reporting is crucial to the quality of clinical care. A retrospective review of family history data collected at a community hospital between 2005 and 2009 was performed in 43,257 women presenting for screening mammography. Reported numbers of breast, colon, prostate, lung, and ovarian cancer were compared in maternal relatives vs. paternal relatives and in first vs. second degree relatives. Significant reporting differences were found between maternal and paternal family history of cancer, in addition to degree of relative. The number of paternal family histories of cancer was significantly lower than that of maternal family histories of cancer. Similarly, the percentage of grandparents' family histories of cancer was significantly lower than the percentage of parents' family histories of cancer. This trend was found in all cancers except prostate cancer. Self-reported family history in the community setting is often influenced by both bloodline of the cancer history and the degree of relative affected. This is evident by the underreporting of paternal family histories of cancer, and also, though to a lesser extent, by degree. These discrepancies in reporting family history of cancer imply we need to take more care in collecting accurate family histories and also in the clinical management of individuals in relation to hereditary risk.     

Rule-based and exemplar-based classification in artificial grammar learning

In this study, we examined the induction of syntactic rules, given the presentation of letter strings generated from a finite-state grammar. Our primary interest was whether application of abstracted syntax or analogy to remembered exemplars could serve as a basis for judgments of grammaticality of novel stimuli. The grammatical status of test items and their objective similarity to studied exemplars were manipulated independently to investigate whether rule-based or instance-based information was a more important determinant of classification performance. When group data were examined, the results indicated that both factors were equally important in influencing grammaticality judgments about novel letter strings. There were, however, large individual differences in the magnitude of grammatical status effects, with a subgroup of subjects clearly using a classification strategy other than analogy to remembered exemplars. The results offer qualified support for the hypothesis (Reber & Allen, 1978) that rule-based information can be implicitly abstracted given limited experience with richly structured stimulus domains, and these results are inconsistent with a strong version of the instance-based model of categorization.     

Assessing teaching opportunities in a residential treatment facility

Seventeen living units in a residential treatment facility for developmentally disabled persons were assessed to determine the availability of teaching opportunities during the course of a normal day's routine. Teaching opportunities exist when the environment is arranged so that residents can participate in the ongoing activities. The teaching opportunities are identified within components that are recognizable activities that occur routinely and have a functional purpose. An assessment form was constructed as a means for documenting teachng opportunities. Assessments were conducted continuously from early morning through evening activities. The results of the assessments suggested that two approaches to resident care were in operation at the facility: one was characterized by a traditional care/custodial model, the other was characterized by a teaching model. On units where the number of teaching opportunities available was high, there was a smaller percentage of unstructured time, i.e., blocks of time when opportunities to engage in structured activities were not available to the residents.     

The importance of ‘mass’ in line drawings of faces

Previous research (Davies, Ellis and Shepherd, 1978; Rhodes, Brennan and Carey, 1987) has shown that accurate line drawings of familiar faces are identified rather poorly. However, artists can produce lifelike portraits with pen and ink, and Pearson and Robinson (1985) described an automatic method for producing computer-drawn sketches (‘cartoons’) of faces which appear very similar to those produced by a human artist. In this paper we show that subjects can identify famous faces depicted in such computer-drawn ‘cartoons’ almost as well as full grey-scale images. The cartoon algorithm comprises two components. One component draws lines at the locations of intensity changes corresponding to luminance valleys and edges (the ‘valledge’ detector). The other component applies a ‘threshold’ to the original intensity distribution, and replaces any area darker than threshold with black. Thus the full cartoon contains both ‘line’ and ‘mass’. Neither the valledges nor the threshold components alone were as well identified as full cartoons containing both components. The results suggest that the addition of the threshold component adds significantly to the identifiability of line drawings of faces.