Intensive Family-Based Cognitive-Behavioral Therapy for Pediatric Obsessive-Compulsive Disorder: Applications for Treatment of Medication Partial- or Nonresponders

Serotonin reuptake inhibitor medications and cognitive-behavioral therapy (CBT) are both effective treatments for pediatric obsessive-compulsive disorder (OCD). Despite recommendations that youth with OCD be treated with CBT alone or together with serotonin reuptake inhibitor medication, many youth are treated with medication alone or with non-CBT psychotherapy initially. Although effective, symptom remission with medication alone is rare (e.g., only 21.4% of youth achieved remission with sertraline in the Pediatric OCD Treatment Study, 2004) and residual symptoms often remain (e.g., 58% of subjects in the March et al. [1998] sertraline trial were not considered treatment responders). This paper reviews the literature on the efficacy of CBT for pediatric OCD, particularly as it relates to the treatment of youth with prior inadequate response to medication. It also describes an intensive, family-based CBT program for children and adolescents with OCD and support for its efficacy among those with prior partial- or nonresponse to medication. Finally, we present a case study of an adolescent girl with OCD who participated in the intensive treatment program after having limited benefit from medication and non-CBT psychotherapy and experienced a favorable response.     

Infants use shared experience to interpret pointing gestures

We investigated whether 1‐year‐old infants use their shared experience with an adult to determine the meaning of a pointing gesture. In the first study, after two adults had each shared a different activity with the infant, one of the adults pointed to a target object. Eighteen‐ but not 14‐month‐olds responded appropriately to the pointing gesture based on the particular activity they had previously shared with that particular adult. In the second study, 14‐month‐olds were successful in a simpler procedure in which the pointing adult either had or had not shared a relevant activity with the infant prior to the pointing. Infants just beginning to learn language thus already show a complex understanding of the pragmatics of cooperative communication in which shared experience with particular individuals plays a crucial role.     

I Recognise You but I Can't Place You: An Investigation of Familiar-only Experiences during Tests of Voice and Face Recognition

In this paper, we examine in detail the situation in which a subject finds that a face or voice is familiar but is unable to retrieve any biographical information about the person concerned. In two experiments, subjects were asked to identify a set of 40 celebrities either from hearing their voice or from seeing their face. Although many more celebrities were identified and named in response to their face than their voice, the results showed that there was a very large number of occasions when a celebrity's voice was felt to be familiar but the subject was unable to retrieve any biographical information about the person. This situation occurred less frequently in response to seeing a celebrity's face; when a face was found familiar, the subject was much more likely to be able to recall the celebrity's occupation. The possibility that these results might have come about because subjects were using different criteria to determine familiarity in the face and voice conditions was investigated and discounted. An additional finding was that when subjects found a face to be familiar-only, they were able to recall significantly more additional information about the person when they were cued by the person's voice than when they simply saw the face again. These results are discussed in relation to the models of person recognition put forward by Bruce and Y oung (1986) and Burton, Bruce, and Johnston (1990).     

Play,agreement and consensus

In this paper I employ the analysis of play to clarify the distinction between an agreement and a consensus, and I argue that it is the conditions supplied by the playful process that enable us to partake in the recognition and creation of truth. Gadamer's hermeneutical truth, unlike propositional truth, speaks of the interpretive act whereby meaning is recognized. This interpretive recognition of meaning is described by Gadamer as an occurrence of interpretive play orgenuine understanding. Regarding Gadamer's conception of truth as modelled on agreement rather than consensus, I demonstrate that it is in the process of play that we achieve the making and maintaining of the conditions that are necessary for agreement, and that the nature of understanding is most clearly revealed by viewing it as a playful process.     

AVERAGENESS, EXAGGERATION, AND FACIAL ATTRACTIVENESS

Abstract— Langlois and her colleagues reported in this journal that composite faces are more attractive than the component faces used to create them, and conjectured that averageness is attractive (Langlois & Roggman, 1990, Langlois, Roggman, & Musselman, 1994) However, extremes may also be attractive (Perrett, May, & Yoshikawa, 1994). We investigated the effect of averageness (proximity to a norm or average face) on attractiveness using a computerized caricature generator to very averageness. Attractiveness increased with averageness (Experiment 1) and was negatively correlated with distinctiveness, a subjective measure of the converse of averageness (Experiments 1 and 2) Extremes (caricatures) were not attractive Line-drawing composites, which avoid some of the problems associated with gray-level composites, were significantly more attractive and less distinctive (more average) than individual faces (Experiment 2) These results support the claim that averageness is attractive.     

Children's selective trust decisions: rational competence and limiting performance factors

Recent research has amply documented that even preschoolers learn selectively from others, preferring, for example, reliable over unreliable and competent over incompetent models. It remains unclear, however, what the cognitive foundations of such selective learning are, in particular, whether it builds on rational inferences or on less sophisticated processes. The current study, therefore, was designed to test directly the possibility that children are in principle capable of selective learning based on rational inference, yet revert to simpler strategies such as global impression formation under certain circumstances. Preschoolers (N = 75) were shown pairs of models that either differed in their degree of competence within one domain (strong vs. weak or knowledgeable vs. ignorant) or were both highly competent, but in different domains (e.g., strong vs. knowledgeable model). In the test trials, children chose between the models for strength‐ or knowledge‐related tasks. The results suggest that, in fact, children are capable of rational inference‐based selective trust: when both models were highly competent, children preferred the model with the competence most predictive and relevant for a given task. However, when choosing between two models that differed in competence on one dimension, children reverted to halo‐style wide generalizations and preferred the competent models for both relevant and irrelevant tasks. These findings suggest that the rational strategies for selective learning, that children master in principle, can get masked by various performance factors.     

Experiences of supervising postgraduate community psychology students at Wits university,South Africa

In this article, the authors discuss problems and challenges of supervising postgraduate community psychology students at the University of the Witwatersrand, South Africa. As part of their community work, students developed community projects in schools in Alexandra Township, aimed at dealing with social ills such as HIV/AIDS, gangs, violence, substance abuse and teenage pregnancy. Students found community work to be extremely exhausting, stressful and demanding. Therefore, community psychology supervision became an important space in helping students to reflect on the experiences, anxieties and frustrations. This article discusses key themes that have emerged in community supervision, including gender, race and class issues. In conclusion, recommendations are provided on how to improve community psychology supervision based our experiences. Supervisors need to be proactive in helping students to reflect on their experiences and actively engage with some of the theoretical and practical issues that emerge in community work. Copyright © 2010 John Wiley & Sons, Ltd.     

The Impact of Child and Family Team Composition on Wraparound Fidelity: Examining Links Between Team Attendance Consistency and Functioning

Although a growing body of literature has examined wraparound implementation and fidelity, child and family team (CFT) members’ levels of participation and the consistency of their attendance have not been systematically examined. This study explored the relationship between CFT member attendance consistency and the fidelity of wraparound team level implementation processes in a System of Care (SOC). Specifically, utilizing Participant Rating Form (PRF) data collected from caregivers, facilitators, youth, supportive persons, and service providers, as well as meeting attendance records, the relationship between team attendance consistency and fidelity of wraparound implementation was explored. Records for 88 teams, with a total of 2,643 members’ ratings of CFT meetings between 2004 and 2009, were examined. Analyses indicate that the structural team factors of attendance consistency and mean team members present relate to CFT members’ ratings of team functioning and the degree to which meeting processes are consistent with the tenets of wraparound. Team attendance variables related to the views of meeting functioning by facilitators, service providers, and caregivers, the individuals most often responsible for implementation of the plan of care, but not ratings by youth or supportive persons. These findings have implications for policy and the successful implementation of wraparound, underscoring the relevance of attending to and tracking the composition of the CFT and more actively encouraging consistent meeting attendance. Results also highlight the need to measure structural variables that may have salience in fidelity and implementation assessments and, more globally, the effectiveness of SOCs.     

Hormonal regulation of delta opioid receptor immunoreactivity in interneurons and pyramidal cells in the rat hippocampus

Clinical and preclinical studies indicate that women and men differ in relapse vulnerability to drug-seeking behavior during abstinence periods. As relapse is frequently triggered by exposure of the recovered addict to objects previously associated with drug use and the formation of these associations requires memory systems engaged by the hippocampal formation (HF), studies exploring ovarian hormone modulation of hippocampal function are warranted. Previous studies revealed that ovarian steroids alter endogenous opioid peptide levels and trafficking of mu opioid receptors in the HF, suggesting cooperative interaction between opioids and estrogens in modulating hippocampal excitability. However, whether ovarian steroids affect the levels or trafficking of delta opioid receptors (DORs) in the HF is unknown. Here, hippocampal sections of adult male and normal cycling female Sprague-Dawley rats were processed for quantitative immunoperoxidase light microscopy and dual label fluorescence or immunoelectron microscopy using antisera directed against the DOR and neuropeptide Y (NPY). Consistent with previous studies in males, DOR-immunoreactivity (-ir) localized to select interneurons and principal cells in the female HF. In comparison to males, females, regardless of estrous cycle phase, show reduced DOR-ir in the granule cell layer of the dentate gyrus and proestrus (high estrogen) females, in particular, display reduced DOR-ir in the CA1 pyramidal cell layer. Ultrastructural analysis of DOR-labeled profiles in CA1 revealed that while females generally show fewer DORs in the distal apical dendrites of pyramidal cells, proestrus females, in particular, exhibit DOR internalization and trafficking towards the soma. Dual label studies revealed that DORs are found in NPY-labeled interneurons in the hilus, CA3, and CA1. While DOR colocalization frequency in NPY-labeled neuron somata was similar between animals in the hilus, proestrus females had fewer NPY-labeled neurons that co-labeled with DOR in stratum oriens of CA1 and CA3 when compared to males. Ultrastructural analysis of NPY-labeled axon terminals within stratum radiatum of CA1 revealed that NPY-labeled axon terminals contain DORs that are frequently found at or near the plasma membrane. As no differences were noted by sex or estrous cycle phase, DOR activation on NPY-labeled axon terminals would inhibit GABA release probability equally in males and females. Taken together, these findings suggest that ovarian steroids can impact hippocampal function through direct effects on DOR levels and trafficking in principal cells and broad indirect effects through reductions in DOR-ir in NPY-labeled interneurons, particularly in CA1.     

Imitation of hierarchical action structure by young children

To provide the first systematic test of whether young children will spontaneously perceive and imitate hierarchical structure in complex actions, a task was devised in which a set of 16 elements can be modelled through either of two different, hierarchically organized strategies. Three-year-old children showed a strong and significant tendency to copy whichever of the two hierarchical approaches they witnessed an adult perform. Responses to an element absent in demonstrations, but present at test, showed that children did not merely copy the chain of events they had witnessed, but acquired hierarchically structured rules to which the new element was assimilated. Consistent with this finding, children did not copy specific sequences of actions at lower hierarchical levels.