Selective and sustained attention in children with spina bifida myelomeningocele

This study examined memory functioning in children and adolescents with 22q11.2 Deletion Syndrome (DS; velocardiofacial syndrome). An overall verbal better than nonverbal memory pattern was evident on the Test of Memory and Learning (TOMAL), with children with 22q11.2 DS performing significantly below their siblings and children with low average IQ but similar to children with autism on facial memory. Children with 22q11 DS also performed significantly below their siblings on tests of verbal working memory. Children with autism performed significantly poorer than the siblings of children with 22q11.2 DS only on their recall of stories. Delayed recall was significantly poorer in children with 22q11.2 DS and children with autism, compared to sibling controls. Although there were no significant group differences on tests of multiple trial verbal or visual learning, a relative weakness was noted with multiple trial visual learning in children with 22q11.2 DS and their siblings, suggesting that an alternative or interactive factor other than the deletion may account for the relatively better verbal compared to nonverbal memory abilities. Deficits in facial memory in children with both 22q11.2 DS and autism suggest disruptions in ventral temporal pathways such as between fusiform gyrus and parahippocampal/hippocampal regions whereas deficits in verbal working memory in children with 22q11.2 DS implicates dorsolateral prefrontal regions, both intimating aberrant white matter pathways.     

Attention Deficits in Children with < 750 gm Birth Weight

Although attention deficit disorders are frequently diagnosed in low birth-weight children, it is not clear if attention problems are apparent in neuropsychological testing. The present study examined the performances of a regional sample of 68 children with birth weights <750 gm on several psychometric measures of attention given at early school age. Matched groups of 65 children with birth weights between 750–1499 gm and 61 term controls were also assessed. The group <750 gm performed more poorly on one attention test than did either comparison group, even when overall cognitive ability was taken into account. Performances on the attention tests were also related to academic skills and ratings of behavior. Findings confirm the hypothesis that children with birth weights <750 gm have specific attentional weaknesses and support the validity of attention tests as predictors of learning and behavior problems.     

Impaired Consonant Trigrams Test (CTT) performance relates to everyday working memory difficulties in children with Autism Spectrum Disorders

Individuals with Autism Spectrum Disorders (ASD) often struggle with complex tasks, such as those requiring divided attention (simultaneously completing two independent tasks) that also place high demands on working memory. Prior research shows that divided attention is impaired in adults and children with ASD and is related to ASD and comorbid attention deficit/hyperactivity disorder (ADHD) symptoms, but the impact on everyday functioning is unclear. Because ADHD symptoms are associated with poor divided attention and working memory performance in children with ASD, we also examined ADHD symptoms as moderators of divided attention performance. We examined performance on the Consonant Trigrams Test (CTT) between high-functioning 8- to 13-year-olds with ASD (n?=?28) and typically developing controls (n?=?18) matched on age and IQ. In the ASD group, we also correlated performance with ADHD symptoms and behavior ratings of everyday working memory. CTT performance in children with ASD was significantly worse than in matched controls. A significant correlation between CTT performance and everyday working memory was observed, but CTT performance was not related to comorbid ADHD symptoms in the ASD group. Divided attention with high working-memory demands is a relative weakness in children with high-functioning ASD; this weakness relates to everyday functioning, and it is independent from ADHD symptoms. That ADHD symptoms are not associated with divided attention performance is inconsistent with one prior investigation, which likely results from using different divided attention tasks in the two studies.     

An adolescent and his imaginary companions: from quasi-delusional constructs to creative imagination

In this paper I shall describe the psychotherapeutic treatment of a 14-year-old boy, who suffered from mild Asperger's syndrome. This adolescent had a multiplicity of imaginary friends, which protected him from catastrophic feelings of loneliness and deadness, but at the same time interfered with the possibility of establishing meaningful relations with human beings. As the relationship with the therapist gradually gained the vitality and importance originally invested in his parallel fantasy world, the imaginary companions simultaneously faded away. His imagination then became more closely connected to inner reality and to creative processes. The psychoanalytic literature on imaginary companions is reviewed, and it is suggested that the concept of a self-protective device could be usefully applied to understanding the functions that this fantasy performed for the patient.

Dans cet article, l'auteur décrit le traitement psychothérapeutique d'un garçon de 14 ans qui présentait une forme atténuée du syndrome d'Asperger. Cet adolescent avait une foule d'amis imaginaires, ce qui, tout en le protégeant contre le sentiment catastrophique de solitude et de morne tristesse, l'empêchait d'établir des rapports authentiques avec des êtres humains. Au fur et à mesure que sa relation à sa thérapeute était investie de la vitalité et de l'importance initialement accordées à son monde fantasmatique parallèle, ses compagnons imaginaires s'effaçaient. Son imagination était alors davantage en contact avec sa réalité intérieure et avec sa créativité. Passant en revue un certain nombre de textes psychanalytiques sur les compagnons imaginaires, l'auteur suggère que le concept d'un dispositif d'auto-protection pourrait aider à comprendre le rôle que jouait pour son patient cet univers fantasmatique.

In questo articolo l'autrice descrive il trattamento psicoterapeutico di un ragazzo di 14 anni con sindrome di Asperger in forma leggera. Questo ragazzo aveva una molteplicita' di amici immaginari che lo proteggevano da sentimenti catastrofici di solitudine e senso di morte, ma che allo stesso tempo interferivano con la possibilita' che egli stabilisse delle relazioni significative con altri esseri umani. Con l'intensificarsi della relazione con la terapeuta, che gradualmente acquisi' la vitalita' ed importanza originariamente investiti nel suo mondo di fantasia parallelo, simultaneamente i compagni immaginari scomparvero. La sua immaginazione divenne allora piu' strettamente connessa con la realta' interna e con i processi creativi. Nell'articolo viene passata in rassegna la letteratura psicoanalitica sui compagni immaginari, e si avanza l'ipotesi che il concetto di manovra protettiva per il se' potrebbe essere utilmente applicato alla comprensione delle funzioni che tale fantasia fungeva per il paziente.

In diesem Artikel werde ich die psychotherapeutische Behandlung eines 14-jährigen Jungens beschreiben, der an leichtem Asperger Syndrom litt. Dieser Jugendliche hatte eine Vielzahl von imaginären Freunden, die ihn vor katastrophalen Gefühlen der Einsamkeit und Leblosigkeit schützten, aber gleichzeitig die Möglichkeit, bedeutsame Beziehungen mit Menschen herzustellen, beeinträchtigten. Als die Beziehung mit der Therapeutin allmählich die Vitalität und Bedeutung erlangte, die ursprünglich in seiner parallellen Phantasiewelt investiert war, verblassten gleichzeitig die imaginären Begleiter. Seine Phantasiewelt war dann näher mit seiner inneren Realität und kreativen Prozessen verbunden. Es wird die psychoanalytische Literatur über imaginäre Begleiter rezensiert und vorgeschlagen, dass das Konzept einer selbst-schützenden Vorrichtung nützlich zum Verstehen der Funktionen angewendet werden kann, die diese Phantasie für den Patienten erfüllten.     

The influence of negative oriented personality traits on the effects of wind turbine noise

Concern about invisible environmental agents from new technologies, such as radiation, radio-waves, and odours, have been shown to act as a trigger for reports of ill health. However, recently, it has been suggested that wind turbines – an archetypal green technology, are a new culprit in explanations of medically unexplained non-specific symptoms (NSS): the so-called Wind Turbine Syndrome ( Pierpont, 2009). The current study assesses the effect of negative orientated personality (NOP) traits (Neuroticism, Negative Affectivity and Frustration Intolerance) on the relationship between both actual and perceived noise on NSS. All households near ten small and micro wind turbines in two UK cities completed measures of perceived turbine noise, Neuroticism, Negative Affectivity, Frustration Intolerance, attitude to wind turbines, and NSS (response N = 138). Actual turbine noise level for each household was also calculated. There was no evidence for the effect of calculated actual noise on NSS. The relationship between perceived noise and NSS was only found for individuals high in NOP traits the key role of individual differences in the link between perceived (but not actual) environmental characteristics and symptom reporting. This is the first study to show this effect in relation to a so called ‘green technology’.     

Relations between symptom severity,illness perceptions,visceral sensitivity,coping strategies and well-being in irritable bowel syndrome guided by the common sense model of illness

Irritable Bowel Syndrome (IBS) is a common condition affecting around 10–20% of the population and associated with poorer psychological well-being and quality of life. The aim of the current study was to explore the efficacy of the Common Sense Model (CSM) using Structural Equation Modelling (SEM) in an IBS cohort. One hundred and thirty-one IBS patients (29 males, 102 females, mean age 38 years) participating in the IBSclinic.org.au pre-intervention assessment were included. Measures included IBS severity (Irritable Bowel Syndrome Severity Scoring System), coping patterns (Carver Brief COPE), visceral sensitivity (Visceral Sensitivity Index), illness perceptions (Brief Illness Perceptions Questionnaire), psychological distress (Depression, Anxiety and Stress Scale), and quality of life (IBS Quality of Life scale; IBS-QoL). Using SEM, a final model with an excellent fit was identified (χ² (8) = 11.91, p = .16, χ²/N = 1.49, CFI > .98, TLI > .96, SRMR < .05). Consistent with the CSM, Illness perceptions were significantly and directly influenced by IBS severity (β = .90, p < .001). Illness perceptions in turn directly influenced maladaptive coping (β = .40, p < .001) and visceral sensitivity (β = .70, p < .001). Maladaptive coping and visceral sensitivity were significantly associated with psychological distress (β = .55, p < .001; β = .22, p < .01) and IBS-QoL (β = –.28, p < .001; β = –.62, p < .001). Based on these findings, we argue that to augment the adverse impact of IBS severity on IBS-QoL and psychological distress, psychological interventions will be best to target the mediating psychological processes including illness beliefs, visceral sensitivity and maladaptive coping.     

Self in time and language

Time has been considered a crucial factor in distinguishing between two levels of self-awareness: the “core,” or “minimal self,” and the “extended,” or “narrative self.” Herein, I focus on this last concept of the self and, in particular, on the relationship between the narrative self and language. In opposition to the claim that the narrative self is a linguistic construction, my idea is that it is created by the functioning of mental time travel, that is, the faculty of human beings to project themselves mentally backwards in time to relive, or forward to anticipate, events. Moreover, I propose that narrative language itself should be considered a product of a core brain network that includes mechanisms, such as mental time travel, mindreading, and visuo-spatial systems.     

The effect of Multi Convergent Therapy on the psychopathology,mood and performance of Chronic Fatigue Syndrome patients: A preliminary study

Objectives: Multi Convergent Therapy combines approaches such as Cognitive Behaviour Therapy and Graded Exercise Therapy in an holistic treatment of Chronic Fatigue Syndrome. Initial follow‐up data showed that patients were benefiting from this individualised form of therapy. The objective of the present study was to evaluate this Multi Convergent approach, developed at a specialised Chronic Fatigue Syndrome Outpatient clinic in Cardiff, and compare it to Relaxation Therapy and control groups using multiple outcome measures. Design: Thirty‐five participants fitting the Centre for Disease Control criteria for Chronic Fatigue Syndrome were recruited from two outpatient clinics and members of our existing patient panel. Patients were assigned to Multi Convergent Therapy (N=12), Relaxation Therapy (N=14) or recruited as controls (N=9). Methods: Each patient completed a battery of mood and performance tasks along with comprehensive set of questionnaires at baseline, post‐treatment and at six‐month follow‐up. These measures had been validated in previous studies on untreated patients and matched healthy controls. Results: Patients attending the Multi Convergent Therapy clinic showed statistically significant improvements in many of our measures. Most importantly we have produced data indicating that Multi Convergent Therapy provides improvements in objective measures of psychomotor performance and cognition. Discussion: The outcomes of this small study are encouraging. Multi Convergent Therapy has not only produced results indicating significant improvements in standardised questionnaire based measures but also in objective cognitive performance tasks. The next step would be to assess Multi Convergent Therapy at the primary medical care level, with a greater number of patients to further evaluate its efficacy as a treatment for Chronic Fatigue Syndrome.     

Doctor-patient relationship and quality of life in Irritable Bowel Syndrome: an exploratory study of the potential mediating role of illness perceptions and acceptance

Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder characterised by unpredictable bowel symptoms. These can be difficult to manage, consequently impacting quality of life (QoL). In addition, a strained doctor–patient relationship is independently reported in the qualitative literature. Given the doctor is often the first port of call for people with IBS, a difficult relationship may influence subsequent IBS management. Research suggests illness perceptions are important in determining IBS outcomes in therapy; however, their association with doctor–patient relationship and QoL is yet to be investigated. This exploratory study aimed to investigate the association between these constructs in IBS, as well as potential mediation by illness perceptions. Online questionnaires measuring doctor–patient relationship, illness perceptions, acceptance and QoL, were completed by 167 participants who reported an IBS diagnosis (144 female, mean age = 44.22 years, SD = 15.91 years). Bootstrapped pathway analysis was used to model the relationship and mediation effects. There was a significant positive correlation between patient–doctor relationship and QoL, r = .258, n = 167, p = .001. There was a significant indirect effect between doctor–patient relationship and QoL through illness coherence and acceptance (bootstrapped estimate = .058, 95%CI Lower-Upper = .02, .095, p = .002). No other indirect effects were observed in combination with good fit indices for the other illness perceptions. Findings suggest a doctor–patient relationship which fosters mutual understanding and helps patients make sense of symptoms, increases their ability to manage their IBS in a psychologically flexible manner, subsequently helping them maintain their QoL.     

‘Making Room for the Other(s)’: A consideration of psychodynamic counselling with women with Asperger’s Syndrome

This paper explores psychodynamic therapy with young women with Aspergers Syndrome through the use of a composite case study. It seeks to make sense of a female patient’s obsession with a figure from celebrity culture – ‘Tom’ from ‘Britain’s Got Talent’. The potential use of ‘Tom’ by the patient as an idealised object, an autistic object, a transitional object and a transformative object is considered. Drawing on Rosenfeld’s concept of pathological narcissism and Meltzer’s concept of ‘aesthetic reciprocity’, the paper seeks to make sense of both the defences that the patient utilises and the impact of the deficits she has experienced. Attention is given to the development of the therapy through the use of play and work in the transference. Gradually, the patient becomes more able to tolerate separateness and in doing so becomes more connected to her own internal world and the feelings of others. In so doing, she becomes more aware of her actual social marginalisation and gains a greater sense of awareness of her diagnosis.