Finding the Body of the Mind: Integrating Occupational Therapy’s Theories of Mutual Regulation and Dysregulation into Psychotherapy

ABSTRACT

A child’s state of emotional dysregulation is often the explicit complaint of parents, teachers, and others involved in child referrals. Psychoanalytic and, more recently, neuropsychoanalytic thinking along with attachment research have created a foundation for understanding the biological and relational development of parent and child emotional engagement. In particular, these perspectives have clarified the nature of what Donald Winnicott termed impingements on the potential space between parent and child. An important addition to the understanding of biological and relational impingements on parent-child emotional dynamics comes from the field of occupational therapy (OT), which views sensory-motor regulatory capacities as forming the basis for quality relating and engaging. From an OT perspective, impingements on relating and adaptive functioning result from compromised regulation of arousal, affect, attention, and activity level on the part of the child, the parent, and/or the child/parent “fit.” Sensory integration and sensory processing theories offer additional frameworks for understanding and communicating with parents about patterns of mutual dysregulation in the parent-child relationship. When integrated with psychodynamic formulations, these ideas from OT research and practice can provide parents with new, more effective and flexible narratives of their children’s inner lives and behavior, and of their own narratives as parents.     

Near-term fetuses process temporal features of speech

The perception of speech and music requires processing of variations in spectra and amplitude over different time intervals. Near-term fetuses can discriminate acoustic features, such as frequencies and spectra, but whether they can process complex auditory streams, such as speech sequences and more specifically their temporal variations, fast or relatively slow acoustic variations, is unclear. We recorded the cardiac activity of 82 near-term fetuses (38 weeks GA) in quiet sleep during a silent control condition and four 15 s streams presented at 90 dB SPL Leq: two piano melodies with opposite contours, a natural Icelandic sentence and a chimera of the sentence--all its spectral information was replaced with broadband noise, leaving its specific temporal variations in amplitude intact without any phonological information. All stimuli elicited a heart rate deceleration. The response patterns to the melodies were the same and differed significantly from those observed with the Icelandic sentence and its chimera, which did not differ. The melodies elicited a monophasic heart rate deceleration, indicating a stimulus orienting reflex while the Icelandic and its chimera evoked a sustained lower magnitude response, indicating a sustained attentional response or more focused information processing. A conservative interpretation of the data is that near-term fetuses can perceive sound streams and the rapid temporal variations in amplitude that are specific to speech sounds with no spectral variations at all.     

Comparison of two methods of MMPI-2 profile classification

The present study investigated the extent of agreement of the highest scale method and the best-fit method in matching MMPI-2 profiles to database code-type profiles and considered profile characteristics that may relate to agreement or disagreement of code-type matches by these two methods. A sample of 519 MMPI-2 profiles that had been classified into database profile code types by these two methods was studied. Resulting code-type matches were classified into three groups: identical (30%), similar (39%), and different (31%), and the profile characteristics of profile elevation, dispersion, and profile code-type definition were studied. Profile code-type definition was significantly different across the three groups with identical and similar match profile groups showing greater profile code-type definition and the different group consisting of profiles that were less well-defined.     

Inhibition and shifting in children with learning deficits in arithmetic and reading

The executive functions of inhibition and shifting were studied in arithmetic-disabled children, reading-disabled children, reading plus arithmetic-disabled children, and controls (N = 74). Measures involved the rapid naming of objects, digits, letters, or quantities with or without additional task requirements that reflected inhibition or shifting. Also, the Making Trails task, reflecting shifting, was administered. For tasks without executive demands, arithmetic-disabled children were slower in the naming of digits and quantities, whereas reading-disabled children were slower in the naming of digits and letters. For the executive tasks, arithmetic-disabled children as well as reading plus arithmetic-disabled children were impaired on the Making Trails task and on an object naming task that required both inhibition and shifting. Reading-disabled children exhibited no problems in executive functioning. Furthermore, it was shown that reading plus arithmetic-disabled children experienced the combination of problems that characterize children with a single learning deficit.     

Speech disruption under delayed auditory feedback in multilingual speakers

The present study investigated the language familiarity hypothesis formulated by Mackay [(1970). How does language familiarity influence stuttering under delayed auditory feedback? Perceptual and Motor Skills, 30, 655-669] that bilinguals speak faster and stutter less under delayed auditory feedback (DAF) when speaking their more familiar language than a less familiar language. Thirty normally fluent native speakers of Dutch (17 males and 13 females, aged between 18;1 and 26;4 years) who were also proficient in French and English read meaningful and nonsense text under DAF in their mother tongue and in the two later acquired languages. The existence of a language familiarity effect was confirmed. The participants required significantly more time and showed significantly more speech disruptions under DAF in the later acquired languages than in the mother tongue, and reading time and number of speech disruptions was significantly higher for the nonsense texts than for the meaningful text for each of the three languages. An additional question addressed was whether or not there were any gender differences in the susceptibility to DAF. Results did not reveal a clear gender difference. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) summarize the importance of language familiarity for the degree of speech disruption experienced by normally fluent multilingual speakers under delayed auditory feedback; and (2) describe gender differences in the susceptibility to delayed auditory feedback.     

Effects of multiple exposures to D-cycloserine on extinction of conditioned fear in rats

Previous research has shown that an acute, post-training injection of D-cycloserine (DCS) facilitates extinction of conditioned fear in rats; however, the effects of multiple exposures to DCS in this situation are not known. In Experiment 1, rats were conditioned (light-shock pairings) and 24 h later given six extinction (light-alone) trials followed by an injection of DCS (15 mg/kg) or saline. The next day, all rats were tested for light-elicited freezing. In Experiment 2, the effect of DCS on extinction was tested in the same manner, except that rats were pre-exposed to DCS (0, 1, or 5 injections) just prior to conditioning. In Experiment 3, rats received five pre-exposures of DCS but conditioning occurred either 2 or 28 days after the last pre-exposure. The results showed that DCS facilitated extinction of conditioned freezing to the light CS when no drug pre-exposure had occurred, but pre-exposure to DCS just prior to conditioning disrupted the facilitation of extinction effect. When 28 days were interposed between pre-exposure and conditioning, the facilitatory effects of DCS on extinction were restored. These findings suggest that DCS has significant clinical value but that behavioral desensitization may occur with multiple exposures; however, desensitization is not permanent and is reduced by the passage of time.     

Impact of executive dysfunctions on episodic memory abilities in patients with ruptured aneurysm of the anterior communicating artery

Executive and memory dysfunctions are among the most frequently reported deficits following a ruptured aneurysm of the anterior communicating artery (ACoA). In order to study the impact of the dysexecutive syndrome on episodic and semantic memory, the data obtained from 59 ACoA patients were examined retrospectively. All patients were assessed on a variety of episodic memory tests (Rey Auditory-Verbal Learning Test, Rey Complex Figure Test, Weschler Memory Scale), semantic memory (verbal fluency), and standardized tests of executive functions (Trail Making Test, Maze tests, Wisconsin Card Sorting Test). There was a strong positive correlation between executive dysfunction and retrieval difficulties in episodic and semantic memory tasks. Comparisons of subgroups of patients with high and low frontal lobe functioning on delayed recall and recognition revealed a significant group X condition interaction in addition to significant group and condition main effects. ACoAs patients with low frontal lobe functioning were particularly deficient in free recall (immediate and delayed) while recognition was equally well preserved in the two subgroups. Neither subgroup presented with an abnormal forgetting over time suggesting a retrieval deficit rather than a true retention impairment.