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.     

Evolution, stress, and sensitive periods: the influence of unpredictability in early versus late childhood on sex and risky behavior

According to a recent evolutionary life history model of development proposed by Ellis, Figueredo, Brumbach, and Schlomer (2009), growing up in harsh versus unpredictable environments should have unique effects on life history strategies in adulthood. Using data from the Minnesota Longitudinal Study of Risk and Adaptation, we tested how harshness and unpredictability experienced in early childhood (age 0-5) versus in later childhood (age 6-16) uniquely predicted sexual and risky behavior at age 23. Findings showed that the strongest predictor of both sexual and risky behavior was an unpredictable environment between ages 0 and 5. Individuals exposed to more unpredictable, rapidly changing environments during the first 5 years of life displayed a faster life history strategy at age 23 by having more sexual partners, engaging in more aggressive and delinquent behaviors, and being more likely to be associated with criminal activities. In contrast, exposure to either harsh environments or experiencing unpredictability in later childhood (age 6-16) was, for the most part, not significantly related to these outcomes at age 23. Viewed together, these findings show that unpredictable rather than merely harsh childhood environments exert unique effects on risky behavior later in life consistent with a faster life history strategy. The findings also suggest that there is a developmentally sensitive period for assessing environmental unpredictability during the first 5 years of life.     

Supervision in aamft accredited programs: Supervisee perceptions and preferences

Abstract

To assess supervisees' perceptions of supervision in AAMFT accredited programs, 72 supervisees from 14 degree programs responded to a questionnaire asking them to describe the supervision they were receiving and what they preferred. The majority reported perceiving their supervision as a mixed didactic-experiential style. Subjects were also asked to describe their perceived actual and preferred supervision on six dimensions. The findings showed that from supervisees' point of view, the quality of supervision in accredited programs is good, that some supervisees do not receive once per week supervision, and that the majority did not receive the style of supervision they preferred.     

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.     

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.     

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.     

The Construct Validity of the Strengths and Difficulties Questionnaire for Aboriginal Children Living in Urban New South Wales,Australia

The current study explores the construct validity of the standard Strengths and Difficulties Questionnaire (SDQ) for Aboriginal children living in urban communities in New South Wales, Australia. Parent report SDQ data from the first 717 Aboriginal children aged 4–17 years who participated in the baseline survey of the Study of Environment on Aboriginal Resilience and Child Health were analysed. The overall construct validity of the SDQ in our sample was acceptable but not “good.” The internal consistency reliability was excellent overall and good for all subscales with the exception of peer problems, a concept that may have a different significance for urban Aboriginal parents. Removing the peer relationships subscale, however, did not improve the fit of the model. The convergent validity of the SDQ was good. The prosocial behaviours scale and both the peer and conduct problems scales were highly correlated suggesting Aboriginal parents conceptualise these differently and that prosocial behaviours may be considered a key indicator of well‐being for Aboriginal children. Overall, the SDQ is a promising tool for urban Aboriginal children in New South Wales. Those working with Aboriginal young people should focus on the SDQ total difficulties score and limit their reliance on the peer relationships subscale.