From affect to feelings and thoughts: from abuse to care and understanding

The capacity of the infant to bear affect relies on the capacity of the caregiver until it has achieved enough strength to perform this task itself. In the case of neglect the necessary strength to contain, metabolize and think about affect so that it may be converted into differentiated feelings cannot develop because of the absence of a caregiver capable of sustaining the infant in its emotional development. Instead a system of defence against affect arises in which the affect itself is perceived as intrusive and abusive. Because of neglect a confusion between abuse and affect is to be observed, with catastrophic consequences for the growing up child. Furthermore neglected children can be seduced by external abuse in the hope of being protected from affect that threatens to feel abusive from within. Paradoxically these children are drawn toward abusive situations in the hope of finding some ongoing shelter from unmanageable affect. A corollary of this is that actual containment comes to feel abusive to them: if they are made to feel affect, they perceive the other, who put them in touch with affect, as abusive: thus affect, abuse and containment are confused. Clinical material will support this thesis.     

A Probabilistic and Individualized Approach for Predicting Treatment Gains: An Extension and Application to Anxiety Disordered Youth

The objective of this study was to extend the probability of treatment benefit method by adding treatment condition as a stratifying variable, and illustrate this extension of the methodology using the Child and Adolescent Anxiety Multimodal Study data. The probability of treatment benefit method produces a simple and practical way to predict individualized treatment benefit based on pretreatment patient characteristics. Two pretreatment patient characteristics were selected in the production of the probability of treatment benefit charts: baseline anxiety severity, measured by the Pediatric Anxiety Rating Scale, and treatment condition (cognitive-behavioral therapy, sertraline, their combination, and placebo). We produced two charts as exemplars which provide individualized and probabilistic information for treatment response and outcome to treatments for child anxiety. We discuss the implications of the use of the probability of treatment benefit method, particularly with regard to patient-centered outcomes and individualized decision-making in psychology and psychiatry.     

Indigenizing CBPR: Evaluation of a Community-Based and Participatory Research Process Implementation of the Elluam Tungiinun (Towards Wellness) Program in Alaska

The process that community based participatory research (CBPR) implementation takes in indigenous community contexts has serious implications for health intervention outcomes and sustainability. An evaluation of the Elluam Tungiinun (Towards Wellness) Project aimed to explore the experience of a Yup'ik Alaska Native community engaged within a CBPR process and describe the effects of CBPR process implementation from an indigenous community member perspective. CBPR is acknowledged as an effective strategy for engaging American Indian and Alaska Native communities in research process, but we still know very little about the experience from a local, community member perspective. What are the perceived outcomes of participation in CBPR from a local, community member perspective? Qualitative methods were used to elicit community member perspectives of participation in a CBPR process engaged with one Yup'ik community in southwest Alaska. Results focus on community member perceptions of CBPR implementation, involvement in the process and partnership, ownership of the project with outcomes observed and perceived at the community, family and individual levels, and challenges. A discussion of findings demonstrates how ownership of the intervention arose from a translational and indigenizing process initiated by the community that was supported and enhanced through the implementation of CBPR. Community member perspectives of their participation in the research reveal important process points that stand to contribute meaningfully to implementation science for interventions developed by and for indigenous and other minority and culturally diverse peoples.     

First symbols in a girl with Down syndrome: A longitudinal study from 12 to 18 months

Symbolic uses of objects originate in communicative and triadic contexts (adult–child-object). In this longitudinal study we explore the emergence and development of the first symbolic uses in triadic interaction contexts in a girl with Down syndrome between 12 and 18-months of age. We conducted five sessions of video recording, at 12, 13½, 15, 16½, and 18 months chronological age. At each session we videotaped the girl and her mother interacting with different objects. Data were coded in semiotic categories used in previous studies (Rodríguez & Moro, 1999) and a microgenetic analysis was conducted for each session. The first symbolic uses by the girl appeared at 13½ months. Symbols were of different types and levels of complexity, and the adult had an important role in facilitating the production of these symbols.     

Investigating letter recognition in the brain by varying typeface: An event-related potential study

We aimed to investigate the contributions of visual letter form and abstract letter identity to the time course of letter recognition, by manipulating the typeface (i.e. font) in which letters were presented. Twenty-six adult participants completed a modified one-back task, where letters where presented in easy-to-read typefaces (“fluent” letter stimuli) or difficult-to-read typefaces (“disfluent” letter stimuli). Task instructions necessitated that participant’s focus on letter identity not visual letter form. Electroencephalography was collected and event-related potentials (ERPs) were calculated relative to letter stimuli. It was found that typeface affected both early-mid (N1 amplitude and P2–N2 amplitude and latency) and late processing (450–600 ms), thereby including time points whereby it is theorised that abstract identity is extracted from visual letter form (that is, 300 ms post-stimulus). Visual features of the letter therefore affect its processing well beyond the currently theorised point at which abstract information is extracted; which could be explained by a feedback loop between abstract letter representations and lower-level visual form processing units, which is not included in current cognitive reading models.     

Collaborative mother–toddler communication and theory of mind development at age 4

Focusing on social pragmatics, this longitudinal study investigated the contribution of mother–toddler collaborative communication to theory of mind (ToM) development at age 4. At age 2½, 78 toddlers (42 boys) and their mothers were observed during pretend play. At age 4, children were tested using 4 false belief understanding tasks. Both mothers and toddlers engaged in more collaborative (inform, guide/request, and support/confirm) than non-collaborative communication acts. Other-focused collaborative acts of support/confirm by mothers and toddlers predicted children's false belief understanding, even after controlling for 5 covariates. In addition, as active agents in their own ToM development, the contribution of toddlers' collaborative acts to false belief understanding was independent of their mother's. Finally, the way toddlers and their mothers co-constructed their communication mattered. Only when toddlers engaged in high levels of collaborative acts, the mothers' high levels of collaborative acts demonstrated a positive effect on children's ToM development. The applied implications of these findings are discussed.     

Predictive validity of the Westmead Post-Traumatic Amnesia Scale for functional outcomes in school-aged children who sustained traumatic brain injury

The Westmead Post-Traumatic Amnesia Scale (WPTAS) is routinely used for the assessment of post-traumatic amnesia (PTA) in children who sustained traumatic brain injury (TBI). Yet, the WPTAS' predictive validity for functional outcomes is largely unknown. We aimed to determine whether PTA duration measured by the WPTAS (i) differentially predicts functional outcomes and (ii) contributes to predictions of outcomes beyond the Glasgow Coma Scale (GCS) in children who sustained TBI. Participants were children and adolescents with moderate-to-severe TBI (n = 55) aged 8–15 years. PTA duration was assessed with the WPTAS. Outcomes at the first outpatient follow-up were scored on the Kings Outcome Scale for Childhood Head Injury (KOSCHI) and the TBI Outcome Domain Scale-Extended (ODS-E). Longer PTA and lower GCS were both significantly correlated with worse (i) global outcomes: presence of disability on the KOSCHI and lower score on the ODS-E and (ii) select specific outcomes on the ODS-E: mobility, mood and cognition. PTA duration predicted cognitive outcome on the ODS-E independently, beyond GCS. Together, PTA duration and GCS, predicted the global KOSCHI outcome, as well as the ODS-E mobility and mood outcomes. Neither GCS nor PTA duration correlated with the ODS-E communication, impulsivity/disinhibition, headache, fatigue, sensory impairments or somatic complaints outcomes. PTA duration measured by the WPTAS is a significant unique predictor of functional cognitive outcomes in children who sustained moderate-to-severe TBI, and in combination with the GCS, a significant predictor of global, and several specific functional outcomes.     

Highly sensitive adolescents: The relationship between weekly life events and weekly socioemotional well-being

Recent research into Person × Environment interaction has supported the view that sensitivity to environmental influences is a susceptibility factor rather than a vulnerability factor. Given this perspective, this study examined the role of the adolescent’s sensory-processing sensitivity in the context of weekly life events and weekly socioemotional well-being. In the study, 114 adolescents repeatedly self-reported their sensitivity, recent life events, and recent socioemotional well-being in four surveys at one-week intervals. The results suggested the shape of Sensitivity × Life Events interaction significantly varied from week to week, which is consistent with the vantage sensitivity and diathesis–stress framework. In specific weeks, adolescents with high sensitivity are more likely to benefit from positive events than those with low sensitivity. These sensitive adolescents can be described as developmentally susceptibility rather than vulnerability.