HIV: How Science Shaped the Ethics

AIDS is a debilitating and fatal disease that was first identified as an infectious disease syndrome in the 1970s. The discovery of a nearly universally fatal infectious and rapidly spreading disease in the post–antibiotics era created apprehension in the medical community and alarm in the general population. Questions about how patients should be handled in medical and nonmedical settings resulted in the ostracizing of many AIDS patients and inappropriate patient management. Scientific investigation into modes of disease transmission and control helped to shape the management of AIDS patient care in such a way that ethical and protective practices could be developed. In this article I discuss some of the ethical questions that were addressed by appropriate scientific inquiry.     

Vulvar pain: a phenomenological study of couples in search of effective diagnosis and treatment

Vulvar vestibulitis syndrome (VVS), a vulvar pain disorder, continues to puzzle medical and mental health professionals due to its unknown etiology and lack of effective treatment. This study used transcendental phenomenology methodology to explore the experiences of couples in which the woman has a diagnosis of VVS. Sixteen in-depth semi-structured interviews were conducted with 13 heterosexual couples and 3 women. Four essences emerged: (1) In search of ... the medical journey required extensive searching for knowledgeable and respectful practitioners to provide treatment. (2) The process of developing a personal understanding of this disorder led many couples to question their role in causing and maintaining VVS. (3) Developing strategies for coping with painful intercourse led to three strategies: becoming non-sexual, using alternatives to vaginal sex, and altering or enduring painful intercourse. (4) Feelings of isolation were experienced as adapting to this chronic pain syndrome was often a lonely process. Clinical suggestions included: treating the couple, not just the woman with VVS; encouraging couples to broaden definitions about the importance and primacy of vaginal intercourse and suggest alternative sexual activities less likely to cause vulvar pain; developing shared meaning as a couple, and assisting couples in locating physicians and resources. Suggestions are relevant for couples with VVS and those with chronic health problems affecting sexual relationships.     

Marriage and Family Therapists’ Ability to Diagnose Asperger’s Syndrome: A Vignette Study

The purpose of this study was to determine the degree to which AAMFT clinical members can accurately diagnose Asperger’s Syndrome. 171 AAMFT clinical members were surveyed using a vignette methodology. Participants were asked to read the vignette and provide a diagnosis for the child in the vignette. Four out of five participants were unable to correctly diagnose the vignette child with Asperger’s Syndrome. Analyses found that the ability to correctly diagnose Asperger’s Syndrome did not vary based on the participants: gender, years of clinical experience, or specialized clinical population (e.g., individuals, couples, families, children). Thomas Stone Carlson is an associate professor and Christi McGeorge is an assistant professor in the couple and family therapy program at North Dakota State University. Sarah Halvorson is a graduate of the couple and family therapy program at North Dakota State University and is in clinical practice in Illinois.     

Global dot integration in typically developing children and in Williams Syndrome

Williams Syndrome (WS) is a neurodevelopmental disorder that results in deficits in visuospatial perception and cognition. The dorsal stream vulnerability hypothesis in WS predicts that visual motion processes are more susceptible to damage than visual form processes. We asked WS participants and typically developing children to detect the global structure Glass patterns, under “static” and “dynamic” conditions in order to evaluate this hypothesis. Sequentially presented Glass patterns are coined as dynamic because they induce illusory motion, which is modeled after the interaction between orientation (form) and direction (motion) mechanisms. If the dorsal stream vulnerability holds in WS participants, then they should process real and illusory motion atypically. However, results are consistent with the idea that form and motion integration mechanisms are functionally delayed or attenuated in WS. Form coherence thresholds for both static and dynamic Glass patterns in WS were similar to those of 4–5 year old children, younger than what is predicted by mental age. Dynamic presentation of Glass patterns improved thresholds to the same degree as typical participants. Motion coherence thresholds in WS were similar to those of mental age matches. These data pose constraints on the dorsal vulnerability hypothesis, and refine our understanding of the relationship between form and motion processing in development.     

Functional Analysis Identified Habit Reversal Components for the Treatment of Motor Tics

This study included brief functional analyses and treatment for motor tics exhibited by two children with Tourette Syndrome. Brief functional analyses were conducted in an outpatient treatment center and results were used to develop individualized habit reversal procedures. Treatment data were collected in clinic for one child and in clinic and school for the other child. Brief functional analysis results were mixed for each child, but provided useful information for informing unique habit reversal components for each child. Treatment results indicated reductions in motor tics for each child. Results are discussed in terms of utility of functional analysis for tics.     

Working with children with Asperger's Syndrome in the mainstream classroom: A psychodynamic take from the chalk face

There has been considerable discussion by those involved in teaching children with special educational needs (SENs) about how to appropriately categorize children with difficulties in learning. Increasingly, a social inclusion model of SEN has come to the fore in mainstream schools across the developed world. Asperger's Syndrome (AS), however, has presented a challenge to inclusionary approaches. This paper, based on the experiences of a teacher working with a child with AS in the mainstream classroom, explores the role of emotions in relation to the obsessional interests of children with AS. Particular reference is paid to the work of later object relations theorists on the emotional role of rigid patterns of thinking, behaviour and obsessional interest in AS. The possibility that an implicit deficit model may at times be relevant to the development of ‘live’ communication and learning for children with AS in the mainstream classroom is considered. Possible management strategies in the classroom in relation to obsessive interests are discussed.     

Transference in the residential treatment of children

Abbreviated version of a lecture delivered before the Medical Section of the British Psychological Society in London on May 24th, 1977.     

Atypical Neuropsychological Profile in a Boy with 22q11.2 Deletion Syndrome Keywords:

In this article the general and specific cognitive impairments of the boy R.H. with a de novo deletion 22q11.2 are described. His full-scale IQ was 73, and he obtained only slightly better verbal than non-verbal subtest scores. Neuropsychological assessment revealed specific impairments in perceptual categorization of objects presented suboptimal, matching of unfamiliar faces, and verbal learning and memory. In contrast, he performed in accordance with his intelligence level on other visual perceptual tasks, on non-verbal learning and memory tasks, and on attention tasks. Voxel-wise statistical comparison of a high-resolution T1-weighted magnetic resonance image of R.H’s brain with similar images obtained from 14 normal control children revealed as major abnormalities a reduction of the right inferior parietal and superior occipital lobe, and a bilateral reduction of deep white matter behind the inferior frontal gyrus. These cognitive impairments and MRI abnormalities are not commonly described in 22q11.2 Deletion Syndrome and may indicate a larger heterogeneity in the neurocognitive phenotype than currently evidenced. At least in this boy the microdeletion seems to have interfered with the development and functioning of particular neural subsystems, while the structure and functioning of other subsystems was left intact.     

An Occupational Therapy Support Service for University Students With Asperger's Syndrome (AS)

Students with Asperger's Syndrome (AS) face challenges, within third-level education, related to the person, environment, and occupation. This study describes an occupational therapy (OT) service that aims to enhance the interplay between the person (i.e., the student) and his/her occupation within a given context (i.e., college environment). A chart review and Student Satisfaction Survey was used to identify the demographics, concerns, and goals of the students using it. It was found that goals and concerns shift according to students' stage in college and recommends that services employ a student-centered, flexible approach responsive to the particular concerns of these students.     

Extended cognition and the space of social interaction

The extended mind thesis (EM) asserts that some cognitive processes are (partially) composed of actions consisting of the manipulation and exploitation of environmental structures. Might some processes at the root of social cognition have a similarly extended structure? In this paper, I argue that social cognition is fundamentally an interactive form of space management—the negotiation and management of “we-space”—and that some of the expressive actions involved in the negotiation and management of we-space (gesture, touch, facial and whole-body expressions) drive basic processes of interpersonal understanding and thus do genuine social-cognitive work. Social interaction is a kind of extended social cognition, driven and at least partially constituted by environmental (non-neural) scaffolding. Challenging the Theory of Mind paradigm, I draw upon research from gesture studies, developmental psychology, and work on Moebius Syndrome to support this thesis.