Establishing the feasibility of direct observation in the assessment of tics in children with chronic tic disorders

Behavior analysis has been at the forefront in establishing effective treatments for children and adults with chronic tic disorders. As is customary in behavior analysis, the efficacy of these treatments has been established using direct-observation assessment methods. Although behavior-analytic treatments have enjoyed acceptance and integration into mainstream health care practices for tic disorders (e.g., psychiatry and neurology), the use of direct observation as a primary assessment tool has been neglected in favor of less objective methods. Hesitation to use direct observation appears to stem largely from concerns about the generalizability of clinic observations to other settings (e.g., home) and a lack of consensus regarding the most appropriate and feasible techniques for conducting and scoring direct observation. The purpose of the current study was to evaluate and establish a reliable, valid, and feasible direct-observation protocol capable of being transported to research and clinical settings. A total of 43 children with tic disorders, collected from two outpatient specialty clinics, were assessed using direct (videotape samples) and indirect (Yale Global Tic Severity Scale; YGTSS) methods. Videotaped observation samples were collected across 3 consecutive weeks and two different settings (clinic and home), were scored using both exact frequency counts and partial-interval coding, and were compared to data from a common indirect measure of tic severity (the YGTSS). In addition, various lengths of videotaped segments were scored to determine the optimal observation length. Results show that (a) clinic-based observations correspond well to home-based observations, (b) brief direct-observation segments scored with time-sampling methods reliably quantified tics, and (c) indirect methods did not consistently correspond with the direct methods.     

FUNCTIONAL ANALYSIS AND TREATMENT OF ELOPEMENT ACROSS TWO SCHOOL SETTINGS

The elopement of a child with Asperger syndrome was assessed using functional analyses and was treated in two school settings (classroom and resource room). Functional analyses indicated that elopement was maintained by access to attention in the resource room and obtaining a preferred activity in the classroom. Attention- and tangible-based interventions were compared in an alternating treatments design in both settings. Results validated the findings of the functional analyses. Implications for the assessment and treatment of elopement are discussed.     

Belief in a just world and subjective well-being: mothers of normal and Down syndrome children

A cross-sectional study examined the relationship between three dimensions of the belief in a just world and the subjective well-being of Pakistani mothers of normal and Down syndrome children (n = 100 each). Personal belief in a just world and two dimensions of general belief in a just world-beliefs in immanent and ultimate justice-were assessed along with four dimensions of subjective well-being: life satisfaction, mood, state anxiety, and depression. It was hypothesized that personal belief in a just world and belief in ultimate justice would be positively associated with subjective well-being for both groups of mothers. Results were obtained through moderated regression analyses. In line with our hypothesis, personal belief in a just world positively predicted life satisfaction and mood level and negatively predicted state anxiety and depression in both groups of mothers. In contrast, beliefs in immanent and ultimate justice were not consistently adaptive. In particular, the more the mothers of a Down syndrome child believed in immanent justice, the more anxiety they experienced the previous week. In addition, the more the mothers of normal children believed in ultimate justice, the more they experienced anxiety. The pattern of results persisted when controlled for mothers' education, the total number of their children and marital status. Overall, the results support the role of personal belief in a just world as a personal resource in adverse as well as normal life circumstances.     

False memories in obstructive sleep apnoea syndrome: evidence from the divided attention paradigm at encoding or retrieval

ABSTRACT

Patients with obstructive sleep apnoea syndrome (OSAS) exhibit impaired retrieval of item-specific information, increasing their propensity to generate false recognitions. The present study investigated the effect of OSAS on false recognition, using a divided-attention paradigm to examine whether reducing the availability of attentional resources during encoding or retrieval in healthy participants mimics the effect of OSAS. We tested four groups of participants, using the Deese – Roediger – McDermott paradigm: patients with OSAS and controls, either under full attention or under divided attention at encoding or retrieval. Results showed that divided attention at retrieval, but not at encoding, mimicked the effects of OSAS on memory performance, as controls in this group exhibited a higher level of false recognition than those under full attention, but a similar level of correct recognition. Our results suggest that the greater susceptibility of patients with OSAS to false recognition may be due to a limited availability of attentional resources, which may specifically disrupt retrieval processes.     

阻塞性睡眠呼吸暂停低通气综合征与舒张性心力衰竭相关性研究进展

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)可诱发舒张性心力衰竭,引起多种临床症状,对患者预后及生活质量产生更多不良影响.其主要病理生理学变化为慢性间歇性或持续性乏氧和高碳酸血症.舒张性心力衰竭发生机制复杂,OSAHS可通过乏氧、神经系统功能改变、炎症反应及水钠潴留而诱发或加重舒张性心力衰竭.OSAHS与舒张性心力衰竭有密切关系,OSAHS可引起并加重心衰,而心衰患者可能会伴发OSAHS,其互为因果,互相促进.在临床治疗方面,我们应充分重视两者相关性及其危害性,制定合理治疗方案.     

The Effect of Differential Post-Weaning Environment on the Rigidity of an Animal's Behavior

Seventy-two first, second and third grade boys and girls were administered seriation problems involving different combinations of shape and color variation. Success rates and latency scores were influenced by shape variation, but not by color variation or grade level. The failure to obtain predicted interactions between the effects of grade level and stimulus variation was attributed to the clarity of the relevant stimulus dimension.     

OCCUPATIONAL AND INDUSTRIAL THERAPY

No abstract available for this article.     

Clinical Commentary

This paper describes a lengthy period of psychotherapy with a child. This treatment began only after a prolonged contact with other child and adolescent mental health services during which the child's difficulties, which had initially seemed to be ordinary behavioural problems, had proved puzzlingly intractable to a variety of interventions. Subsequent psychotherapy revealed a profound disorder of development which lay bath the Surface presentation. In a climate where Asperger's syndrome is often felt to be untreatable, this paper argues that some children, at least, can benefit from psychotherapy and can be helped towards real mental growth. Asperger's syndrome in children bears some striking similarities to narcissistic personality disorder as described in the adult psychoanalytic literature and this paper discusses some of the theoretical and clinical implications of the innate origins of Asperger's syndrome.     

Cerebellar mutism

Cerebellar mutism occurs in about 25% of children following posterior fossa tumor surgery. It is usually accompanied by other neurological and behavioral disturbances. Mutism is transient in nature lasting several days to months and is frequently followed by dysarthria. In addition, impairment of language and other neuropsychological functions can be found after long term follow up in the majority of patients. The pathophysiological background of mutism may be higher speech dysfunction mediated by crossed cerebello-cerebral diaschisis which is frequently found during the mute period. Foremost injury to the bilateral dentatothalamocortical tract appears to be critical for the development of cerebello-cerebral diaschisis and subsequent mutism. Direct cerebellar injury is the likely reason for persisting deficits after the mute period. Minimization of injury to the dentatothalamocortical tract during surgery may be promising in the prevention of mutism. While there is no established treatment of mutism, early speech and rehabilitation therapy is recommended.     

The role of attitudes towards the targets of behaviour in predicting and informing prenatal testing choices

Research considering the role of attitudes in prenatal testing choices has commonly focused on the relationship between the attitude towards undergoing testing and actual testing behaviour. In contrast, this study focused on the relationship between testing behaviour and attitudes towards the targets of the behaviour (in this case people with Down syndrome (DS) and having a baby with DS). A cross-sectional, prospective survey of 197 pregnant women measured attitudes towards the targets of prenatal testing along with intentions to use screening and diagnostic testing, and the termination of an affected pregnancy. Screening uptake was established via patient records. Although attitudes towards DS and having a baby with DS were significantly associated with screening uptake and testing and termination intentions, unfavourable attitudes were better than favourable ones at predicting these outcomes. For example, in the quartile of women with the ‘most favourable’ attitude towards people with DS 67% used screening although only 8% said they would terminate an affected pregnancy. Qualitative data suggested that not all women considered personal attitudes towards DS to be relevant to their screening decisions. This finding has implications for the way in which informed choice is currently understood and measured in the prenatal testing context.