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.     

Global and Local processing in Williams Syndrome: Drawing versus Perceiving

It has been hypothesized that a local processing bias underlies overall visuospatial impairments in Williams syndrome (WS). However, recent studies have challenged this hypothesis by providing evidence against a local processing bias at the perceptual level. The aim of the present study was to further examine drawing and perceptual skills in children with WS using closely matched-hierarchical stimuli. In the drawing task children with WS exhibited a local processing bias. However, no significant preferential bias was found in the perceptual task. This indicates that children with WS do not systematically present a preferential bias for local information. Taken together the findings of the present study suggest that perceptual processing deficits per se are unlikely to explain local processing biases in visuoconstructive tasks often described in people with WS.     

Environmental sound recognition by timbre in children with Williams syndrome

Anecdotal reports have described children with Williams syndrome (WS) as presenting outstanding skills for recognizing environmental sounds by their timbre. This has led to suggest that the skills for environmental sound recognition by timbre are highly developed in WS. Furthermore, the term hypertimbria has been proposed to refer to this feature. However, no academic research has assessed these skills in WS. This study therefore aimed to contrast the reports on the highly developed skills for environmental sound recognition by timbre in children with WS. An environmental sound recognition task was administered to children with WS, children with Down syndrome of the same chronological age and cognitive level, and chronological age-matched typically developing children. Participants with WS performed significantly lower than their typically developing peers and no significant differences were found between the WS and Down syndrome groups. Unlike previous reports, this study points out that in WS environmental sound recognition by timbre does not constitute a phenotypic strength either in absolute or relative terms. Results suggest that children with WS do not present hypertimbria or preserved skills for timbre recognition. We discuss the implications of these results for theories of cognitive modularity.     

Autism spectrum conditions among children and adolescents: A new profiling tool

There is considerable debate about the sociocognitive features of autism spectrum conditions (ASC), and a tool for profiling the sociocognitive profiles of children and adolescents with ASC is needed. The aim of this research was to evaluate the psychometric properties of a new questionnaire—The Australian Scale for Autism Spectrum Conditions (ASASC). Three hundred twenty‐two parents of children on the ASC spectrum, including autistic disorder (n = 76), Asperger's disorder (n = 188), and pervasive developmental disorder not otherwise specified (n = 21), and a clinical group of children with subclinical ASC features and no ASC diagnosis (n = 37). Measures include an initial scale measuring eight potential dimensions of ASC, a related screening tool for autism, and two previously validated social skills questionnaires. The questionnaires were administered online. The ASASC was factor‐analysed, internal and test–retest reliabilities (for a randomly selected 84 parents) were calculated, and preliminary tests of convergent and divergent validity were conducted. The resulting measure (44 items) contained five coherent and reliable dimensions: understand and express emotion, fact orientation, sensory sensitivity, social communication, and rigidity. The questionnaire had good test–retest reliability and convergent/divergent validity. The ASASC enables profiles of ASC symptomatology that should be useful in adjusting interventions to individual needs.     

Changes in illness-related cognitions rather than distress mediate improvements in irritable bowel syndrome (IBS) symptoms and disability following a brief cognitive behavioural therapy intervention

Objective

A previous randomised controlled trial demonstrated that a cognitive behavioural therapy (CBT) self-management intervention significantly improved irritable bowel syndrome (IBS) symptoms and disability compared to treatment as usual (TAU). The current study analysed additional data to establish whether; 1) cognitive, behavioural and emotional factors hypothesized to perpetuate IBS symptoms and disability changed following CBT and, 2) ascertain if changes in these factors over the intervention period mediated treatment effects 6-months later.

Method

IBS patients (CBT = 31, TAU = 33) completed measures pre-and-post intervention including: Brief Illness Perception Questionnaire, Hospital Anxiety & Depression Scale and Cognitive and Behavioural Responses to Symptoms Questionnaire. Path models were evaluated to determine whether changes in cognitive and behavioural factors over the treatment period mediated treatment effects.

Results

Compared to TAU, CBT patients showed significant positive changes on several cognitive variables but not anxiety and depression following intervention. Positive change in illness perceptions following intervention mediated the treatment effect on improved IBS symptom severity and social adjustment six months later. Changes in damaging beliefs mediated the effect on social adjustment.

Conclusions

Change in cognition rather than mood mediated treatment related improvements. Changing negative perceptions of IBS appears to be a particularly important treatment mechanism.     

Why We Should Avoid the use of the Term “Post-Abortion Syndrome”: Commentary on Boulind and Edwards (2008)

Boulind and Edwards (2008) present a case study of Grace, a women suffering, in their words, from post-abortion syndrome (PAS). In this commentary I argue that while Boulind and Edwards' (2008) report is useful in terms of documenting the therapeutic processes engaged in, they would have been better served in not hanging the distress experienced by Grace on the diagnostic category of post-abortion syndrome. Reasons for this are that: PAS is not a recognised category of diagnosis, despite having been initially proposed in 1981; applying a PTSD framework to abortion is questionable; PAS focuses attention on the abortion itself in isolation from the fact that abortion occurs in the context of severely problematic pregnancies and other important socio-cultural stressors; PAS, in the very manner in which it is formulated, invokes to a very complex politics of the foetus. Boulind and Edwards (2008) are careful in their documentation of the complexities of the case, and thus their use of PAS is unfortunate.     

空巢老人心理健康的现状及研究述评

空巢老人的心理健康引起了国内外研究者们的高度关注,逐渐成为一个热点课题.在综合国内外有关空巢老人心理健康的研究文献后发现,目前,学界对空巢老人的界定并不统一;从其心理健康现状来看,空巢综合症是空巢老人各种身心症状的主要体现,主要受社会支持、性别、婚姻状况、经济收入以及其他一些社会人口学因素的影响.虽然对空巢老人心理健康的研究已取得一些成就,但仍存在一些尚待解决的问题,未来研究应从统一空巢老人的涵义,完善研究方法,深入对其自身内部心理因素的探讨及加强跨文化的比较与借鉴等方面来开展.     

Functional Somatic Syndromes and Childhood Physical Abuse in Women: Data From a Representative Community-Based Sample

This study investigated whether childhood physical abuse was associated with functional somatic syndromes (FSS) in women while controlling for age, race, and four clusters of potentially confounding factors: (a) Other childhood adversities, (b) adult health behaviors, (c) socioeconomic status and stressors, and (d) mental health. A regional subsample of the 2005 Canadian Community Health Survey of 7,342 women was used. Women reported whether they had been diagnosed with chronic fatigue syndrome (CFS), fibromyalgia (Fm), irritable bowel syndrome (IBS), or multiple chemical sensitivities (MCS). Fully 749 reported having been physically abused by someone close to them during their youth. When controlling for potentially confounding factors, childhood physical abuse was significantly associated with CFS (OR = 2.11; 95% CI = 1.22, 3.65), Fm (OR = 1.65; 95% CI = 1.08, 2.52), and MCS (OR = 2.82; 95% = CI 1.90, 4.17). Clinicians using reattribution and stepped care approaches in the management of FSS should assess for a history of abuse.