Childhood Epilepsy and Autism Spectrum Disorders: Psychiatric Problems, Phenotypic Expression, and Anticonvulsants

Epilepsy and autism spectrum disorders (ASDs) frequently co-occur during childhood, however, the characteristics of psychiatric or behavioural problems in these children remains largely unknown. This article contributes to these discussions by reporting on the prevalence and presentation of psychiatric or behavioural problems in children with epilepsy and ASDs, as well as on the use of anticonvulsants in these children. The current evidence suggests that children with epilepsy and ASDs may present with a distinct clinical profile, with a greater number of developmental difficulties, and a more severe expression of the ASD phenotype that can not solely be accounted for by level of intellectual functioning. Positive effects of anticonvulsants on behavioural symptoms associated with ASDs were also reported, though pharmacoresistance and a lack of clear treatment guidelines may contribute to an elevated risk of adverse side effects. In relation to clinical presentation and management there is a need for careful consideration of potential interaction effects between disorder specific factors (e.g., age of seizure onset/ASD diagnosis), cognitive characteristics (e.g., intellectual functioning, memory), and psychosocial variables (e.g., coping strategies). Ultimately however, many conclusions are tentative and this review highlights the need for more empirically validated research on children with epilepsy and ASDs.     

Oedipus matters

Abstract

Using experience of working clinically in South Africa, a powerfully racialized society, this paper argues that the Oedipal period, associated in psychoanalytic theory with the formation of gender identity and the shaping of sexual desire, is also a period during which perception of racial identity affects entry into the social world. During this pivotal developmental period, marked by awareness of encounters with gender difference and experiences of erotic exclusion and inclusion, children also become aware of racial differences and their effects on class, privilege and custom. The paper suggests that the anxieties, competitive energy, hope, hate and dread that accompany the child's Oedipal strivings are frequently compounded by encounters with forms of social difference both in and beyond the family. Assumption of a gendered identity, in many contexts, is inseparable from the conscious and unconscious habitation of a racialized identity, which emerges during exactly the same period. Just as our gender identity is both simple and infinitely variable and complex, our awareness of our race is also on one level simple – ‘black/white’ – and on another extremely complex. The paper argues that the working through of Oedipal anxieties will cast light and shadow on every intimate relationship, and will also determine whether other kinds of difference, including racial difference, are met with fear or competitiveness, idealization or denigration, joyful curiosity or withdrawal. The argument draws on post-Freudian, relational and self-psychoanalytic theory, and emphasizes the variability of developmental paths and their construction in powerful social, economic and political contexts, all of which have fundamental effects on biology and bodies. Major influences on the argument are psychoanalytic gender theorists, specifically Jessica Benjamin and Jody Messler Davies, and the work of Franz Fanon.     

Linking spirituality to workplace benefits: An analysis of the Brazilian Candomblé

Spirituality has been an influential force for many people. Although often ignored in business settings, it has recently been a topic of heightened interest to managers and scholars worldwide. In Bahia, Brazil, the fundamentals of spirituality for some have existed through Candomblé and have been an integral part of the community including the workplace. Candomblé encompasses a variety of African religious traditions established in Brazil during the nineteenth century. This study examines the positive influences of the Brazilian Candomblé on workers and business life in Bahia. Through qualitative analysis, it offers organisational insights and managerial reflections that can be adapted and used in workplaces worldwide.     

Poetry for the Uninitiated: Dannie Abse’s “X-Ray” in an Undergraduate Medicine and Literature Class

I recently taught an upper-division Honors class in Medicine and Literature with students ranging from a pre-physician’s assistant student and nursing student to English, French, History, and Technical Writing majors. The common thread connecting these students initially was their self-described fear of and helplessness with poetry. However, as the semester drew to a close, their class discussion and journals revealed not only increased comfort with poetry but also a preference for it. The information and insight they got from poetry, they said, were the reason they took a medical humanities course in the first place and commented that the poetry we read provoked more substantial “medicine and literature” discussions than prose. Poetry provides a good starting place to analyze complex human relationships, and the focus on language and form levels the intellectual playing field: students are all unfamiliar with how to do it and are learning a new skill together. This could be accomplished, of course, with a literary short story, but for the diverse population of students in this class, the brevity of poetry made it all the more appealing.     

Understanding the utility of emotional approach coping: evidence from a laboratory stressor and daily life

Background: Dispositional emotional approach coping (EAC) marks an adaptive tendency to process and express emotions. EAC's association with cognitions, affect, and intra- and interindividual characteristics that may account for its utility was examined in response to an acute stressor and in daily life. Design: This study included a laboratory stress task and ecological momentary assessment. Methods: Healthy undergraduate students (n = 124; mean age: 20; women: 56%) completed a laboratory component (baseline survey, speech stress task, pre- and posttask measures) and five subsequent days of surveys via palm pilot (six surveys/day). Results: Controlling for sex, neuroticism, and social support, greater EAC was associated with more positive cognitive appraisals, personal resources, and positive affect and less-negative affect during the lab stressor, and with more perceived control and positive affect in daily life. Significant EAC × sex interactions were found for poststressor affect: men with high EAC reported more positive affect and women with high EAC reported less negative affect. Conclusions: Findings provide support that EAC's utility may be independent of intra- and interindividual characteristics, and that men and women may benefit from EAC in different ways in regards to affect. The proclivity to use EAC may come with a resiliency that protects against stress and promotes general well-being.     

Visual Abilities in Older Adults Explain Age-Differences in Stroop and Fluid Intelligence but Not Face Recognition: Implications for the Vision-Cognition Connection

The associations among age, visual abilities and cognitive abilities were investigated using structural equation modeling. Measures of Visual Acuity, Colour Vision, Contrast Sensitivity, Stroop, Face Recognition and Fluid intelligence (Gf) were administered to a volunteer sample (n = 90) aged 60-87. Visual Acuity was associated with Gf even after controlling for chronological age. Age differences in Stroop were explained entirely by Colour Vision performance. However, neither Visual Acuity nor Colour Vision explained age-differences in Face Recognition. The results show that performance on some neuropsychological tests is influenced by visual ability and challenge the conventional identification of ageing effects on the Stroop task with deficits in frontal executive functioning. Visual abilities do not, however, contribute to age-differences in all cognitive domains suggesting that sensory and cognitive performance declines are not necessarily due to common biological ageing processes.     

Visual Perspective Taking in Children: Further Ramifications of an Information-Processing Model

Forty children between ages 6 and 8 were administered a set of spatial perspective tasks. On half of the items, children responded by rotating a duplicate of the target display; on the remainder, children reconstructed the displays to correspond to a perspective view. The displays differed as to whether they contained marked or unmarked objects. On the basis of an information-processing analysis of these tasks, we predicted that the response-type variables and stimulus variables would interact in known ways. Analysis of variance results revealed a good fit with the hypothesized outcomes. Main effects were detected for age, which favored older children, and for display, which favored unmarked objects; the rotation task proved easier. Significant interactions revealed that task demands increasing task difficulty were more problematic in the construction task than in the rotation task, as predicted.     

Rorschach Productivity as Related to Verbal Reinforcement

The Rorschach was administered to four groups of 25 college Ss equated for verbal intelligence. A continuous reinforcement group, a human content reinforcement group, and an animal content reinforcement group were compared with a no reinforcement control group. Verbal reinforcement applied after each response significantly increased total R for Ss both aware and unaware of the response-reinforcement contingency. In the human and animal content reinforcement groups, verbal reinforcement led to increased human and animal responses respectively, but only for Ss aware of the reinforcement contingency. Implications for the projective test situation were discussed in terms of E bias and S conformity to experimental demands.