A clinical trial of continuous, intermittent and overlearning ‘bell and pad’ treatments for nocturnal enuresis

Sixty-one enuretic children were allocated sequentially to ‘standard’, ‘intermittent’ or ‘overlearning’ bell and pad treatment. The results suggest that the ‘overlearning’ modification of standard treatment was successful in bringing about a reduction in the relapse rate. The present status and implications of research into nocturnal enuresis were discussed in the light of the results of the investigation.     

Oral overcorrection: side effects and extended applications.

Experiment 1: In a specialized daycare program the use of oral overcorrection (contingent toothbrushing with an oral antiseptic) to suppress one child's thumbsucking at Language Time was found to suppress the behavior of another child who was not treated but who witnessed the target child's treatment. Experiment 2: The main effects of oral overcorrection were replicated. Contingent overcorrection threats (warnings), used independently, were then shown to suppress thumbsucking behavior that had returned to its baseline level. These effects were maintained one month after the threats were discontinued, but they did not generalize to other activity periods, particularly Nap Time. Experiment 3: Contingent threats were found to suppress the persistent nap-time thumbsucking of the child from Expt 2. Increments in certain other (nonoral) inappropriate behaviors were correlated with the suppression of thumbsucking. Threats to use oral overcorrection contingent upon nonoral misbehaviors at Nap Time were not effective. However, the actual use of oral overcorrection for these categories of nonoral misbehavior served to suppress these behaviors. Experimental controls combined treatment reversal and multiple baseline single-subject designs.     

The Hospital Anxiety and Depression Scale: a pilot study to examine its latent structure and the link between psychological state and symptom severity in transient ischaemic attack patients

Transient ischaemic attack (TIA) is often associated with anxiety and depression, which may precipitate secondary stroke and interfere with treatment. The Hospital Anxiety and Depression Scale (HADS) is widely used to assess these states and to inform the management of any associated psychological problems, but there is considerable debate about what it actually measures. The HADS scores from a range of different clinical groups have been reviewed in order to assess its psychometric properties, but so far, no research has examined either its latent structure when used with TIA patients, or the association between symptom severity and the test’s validity. The aims of this study, therefore, were to investigate: (a) the underlying structure of the HADS when used with TIA patients; and (b) the impact of symptom severity on the validity of the HADS. The HADS and a functional capacity measure were administered by post to a sample of 542 confirmed TIA patients. Exploratory factor analysis was conducted on the HADS scores to establish its underlying structure for this clinical group, and then, sub-sample correlations were undertaken between the anxiety/depression scores for different levels of functional capacity. Two factors emerged, with 13 of the 14 HADS items loading significantly on both, suggesting there is a common affective state underlying the standard anxiety and depression scales. Further data-exploration indicated that convergence between these affective states increased as functional capacity deteriorated. The results suggest firstly that the HADS measures general subjective distress when used with TIA patients, and secondly that the higher reported symptom severity in this clinical group may be associated with reduced affective differentiation. As the ability to retain clear affective discrimination is associated with health and well-being, this could provide a focus for post-TIA rehabilitation.     

Message in a bottle: a comparative study of spiritual needs of children and young people in and out of hospital

Using the metaphor of a message in a bottle as a framework and sending an S.O.S. to adults, the question of what are the three biggest needs of children and young people was asked. Data consisting of 107 important needs of children and young people was collected from 36 children and young people both in and out of hospital: in hospital by chaplains and other health care professionals, and out of hospital by children and youth work undergraduate students. This was a convenience sample across the United Kingdom with the majority of respondents in the Midlands. The data were coded and then thematically analysed and separately compared to Maslow’s hierarchy of needs. Emotional needs was the largest theme for hospitalised children and young people and relationship needs for the non-hospitalised children and young people. For both groups Maslow’s level 3 need of belonging was the greatest averaging at just over half the needs shared. A discussion of the results of the analyses identifies some ways in which the needs of hospitalised children and young people may differ, identifying some implications for practice.     

Don’t tell me I’m normal: inpatient psychotherapy of a severely abused patient at the Cassel Hospital

This paper is a case study of a patient with severe personality disorder undergoing treatment at the Cassel Hospital. It looks at a phase of her individual psychoanalytic psychotherapy and how that sits within an institutional model of treatment that can be understood as applied psychoanalysis, in which Tom Main’s concept of a ‘culture of enquiry’ aims to observe and bring together splitting and projective processes operating at all levels of the organisation. The patient, who had been sexually abused and then suffered a prolonged suicidal breakdown, exerted intense pressure on the institution through her experience of herself as both a victim of abuse and a participant in it. A working through is described, in which different parts of the patient that had been projected into different parts of the institution are brought together, and her primitive demand for a two-person world gives way to an acceptance of triangulation. Themes from her individual sessions are enacted in the milieu-based treatment, and conversely struggles in the patient community appear in her sessions. It is from drawing these parts of the patient together as a whole institution that the treatment derives its power and effectiveness.     

Was William James a Patient at McLean Hospital for the Mentally Ill?

Rumors that William James was a patient at McLean Asylum near Boston have persisted for several decades. I focus on the reasons why the question has been so difficult to answer in any definitive way; assess the evidence presented in support of the rumors; note that two different periods in James’s life (late twenties and early sixties) have been judged the most likely; and explore the diagnostic question as well: If he was in fact a patient, for what was he being treated? I also discuss evidence that his younger brother Robertson was a patient at McLean and consider the bearing of this evidence on the question of whether William James was a patient at McLean and on the diagnostic issue.     

A developmental perspective on reading dysfunction: Accuracy and rate criteria in the subtyping of dyslexic children

Children referred with specific reading dysfunction were subtyped as accuracy disabled or rate disabled according to criteria developed from an information processing model of reading skill. Multiple measures of oral and written language development were compared for two subtyped samples matched on age, sex, and IQ. The two samples were comparable in reading fluency, reading comprehension, word knowledge, and word retrieval functions. Accuracy disabled readers demonstrated inferior decoding and spelling skills. The accuracy disabled sample proved deficient in their understanding of oral language structure and in their ability to associate unfamiliar pseudowords and novel symbols in a task designed to simulate some of the learning involved in initial reading acquisition. It was suggested that these two samples of disabled readers may be best described with respect to their relative standing along a theoretical continuum of normal reading development.