A Survey on Driving in Clients With Mental Health Disorders

Few studies have explored driving issues in adult mental health. In this pilot study, 48 drivers were compared to 24 participants who had ceased driving, on their clinical and driving characteristics. Driving-related services offered to them were also documented. Participants who had stopped driving were more likely to be in-patients on antipsychotic or several medications. A third of the participants reported negative effects of their illness and/or medications on driving. Psychiatrists and occupational therapists offered assessments and recommendations related to fitness to drive to 30% of their clients using complementary approaches. This survey indicates that few drivers with mental health disorders receive driving-related services. More evidence-based practice guidelines are needed.     

Next Steps in Validation

No abstract available for this article.     

The Role for Occupational Therapists in Community Mobility Training for People With Autism Spectrum Disorders

Symptoms and behaviors of Autism Spectrum Disorders can challenge community mobility, thus hindering independence and participation in occupation. Community mobility, also called travel training, helps people make journeys safely using public transportation, enabling engagement in activities/services otherwise unavailable. Yet, few articles have been written about this topic for people with Autism Spectrum Disorders. The purpose of the authors in this article is to: (1) explain the need for travel training with people diagnosed with Autism Spectrum Disorders; (2) describe specific travel training assessments; (3) review literature on travel training programs; and (4) define a role for occupational therapy in travel training with individuals diagnosed with Autism Spectrum Disorders.     

Targeting avoidance via compound extinction

ABSTRACT

Avoidance towards innocuous cues is a key diagnostic criterion across anxiety-related disorders. Importantly, the most effective intervention for anxiety-related disorders, exposure therapy with response prevention, sometimes does not prevent the relapse of anxiety's symptomatology. We tested whether extinction effects, the experimental proxy of exposure, are enhanced by increasing the discrepancy between the prediction of an unpleasant event happening (shock presentation), and the actual event (shock omission). Forty-eight individuals first saw pictures of three stimuli. Two pictures (CSA, CSB) were followed by a shock (US) and one (CS-) was not. Next, participants learned to avoid the US by pressing a computer key. An extinction and response prevention procedure followed. In the first part of it, participants saw unreinforced presentations of all CSs. In the second part, the single group saw unreinforced presentations of the CSA and CS-. The compound group encountered compound unreinforced presentations of the CSA and CSB, and separate presentations of the CS-. Return of avoidance and fear was tested after unsignalled presentations of the US. Compound extinction resulted in comparable reduction of fear and avoidance compared to standard extinction. We discuss how future research could enhance extinction effects by adding costs to the avoidance behaviour.     

Body and meaning

Abstract

This paper discusses the very important but disregarded theme of somatization. Somatizers comprise a wide-ranging group of patients, who normally choose to consult doctors rather than psychoanalysts for treatment. We present two clinical reports of somatizing patients in which the psychoanalyst played a considerable role in the study and treatment of their problems. The subjects were not only totally relieved of their physical symptoms, but also dramatically changed their psychic lives.     

Memory Functioning in Children with Reading Disabilities and/or Attention Deficit/Hyperactivity Disorder: A Clinical Investigation of their Working Memory and Long-Term Memory Functioning

We examined memory functioning in children with reading disabilities (RD), Attention deficit/hyperactivity disorder (ADHD), and RD/ADHD using a clinic sample with a clinical instrument: the Children's Memory Scale, enhancing its generalizability. Participants included 23 children with RD, 30 with ADHD, 30 with RD/ADHD, and 30 controls. Children with RD presented with reduced verbal short-term memory (STM) but intact visual STM, central executive (CE), and long-term memory (LTM) functioning. Their deficit in STM appeared specific to tasks requiring phonetic coding of material. Children with ADHD displayed intact CE and LTM functioning but reduced visual-spatial STM, especially when off stimulant medication. Children with RD/ADHD had deficits consistent with both disorders.     

Developmental Changes in Semantic Verbal Fluency: Analyses of Word Productivity as a Function of Time,Clustering, and Switching

We investigated age-related improvement in semantic category verbal fluency (VF) in 309 Dutch schoolchildren attending first to ninth grade. Quantitative analyses of number of correct responses as a function of time as well as qualitative analyses of clustering and switching were conducted. Overall, Dutch VF task performance, i.e., number of correct responses over 60 seconds, was not established before mid-adolescence. This is in line with previously published studies, using VF number of correct responses over 60 seconds as the main outcome measure and examining VF task performance across other cultures and languages (e.g., Italian, French, Hebrew). Next, mean cluster size, a measure of lexico-semantic knowledge, was not established until at least grade 3. In contrast, performance on the VF outcome measures “number of switches/clusters” was established at least 4 years later. Qualitative and quantitative Design Fluency (DF) outcome measures support the notion that the numbers of switches/clusters are valid measures of higher order cognitive functions, such as strategy use and cognitive flexibility. In line of this, VF number of correct responses during 16–60 seconds, a measure of controlled information processing, is established at least 2 years later (i.e., grades 7–8) than number of correct responses during the first 15 seconds time slide, a measure of automatic processing. Finally, environment, i.e., the level of parental education, primarily affected automatic and lexico-semantic knowledge. No effects of sex on VF performance were found. These data suggest that the alternative scoring methods of VF tasks can be used to acquire knowledge on development of lower and higher order cognitive functions in healthy children and the influence of the environment on it.     

Improving executive functioning in children with fetal alcohol spectrum disorders

An extensive body of literature has documented executive function (EF) impairments in children with fetal alcohol spectrum disorders (FASD); however, few studies have aimed specifically at improving EF. One treatment program that shows promise for children with FASD is the Alert Program for Self-Regulation®, which is a 12-week treatment specifically designed to target self-regulation, a component of EF. The present study sought to examine if Alert would produce improvements in self-regulation that would generalize to other aspects of EF, behavior, and social skills in children with FASD. Twenty-five children aged 8–12 years diagnosed with an FASD were assigned in alternating sequence to either an immediate treatment (TXT) or a delayed treatment control (DTC) group. Both groups received a comprehensive evaluation of EF at baseline and upon completing therapy (TXT), or after a 12- to 14-week interval from baseline (DTC). Parents also completed questionnaires assessing EF and behavior at both time points. For the TXT group only, parent questionnaires were readministered at 6-month follow-up. At the 12-week follow-up, the TXT group displayed significant improvements in inhibitory control and social cognition. Parents of children in the TXT group reported improved behavioral and emotional regulation, as well as reduced externalizing behavior problems. These behavioral improvements along with further improved parent-rated inhibitory control was maintained at the 6-month follow-up. The EF disabilities in children with FASD can be remediated through a targeted treatment approach aimed at facilitating self-regulation skills.