Revisiting ‘What works for whom?’: A qualitative framework for evaluating clinical effectiveness in child psychotherapy

This paper describes a framework for evaluating the effectiveness of child psychotherapy used by child psychotherapists in an inner city Child and Adolescent Mental Health Service (CAMHS). The Hopes and Expectations for Treatment Approach (HETA) involves using the assessment for psychotherapy that normally precedes treatment to derive a baseline from which to generate a set of hopes/expectations as regards the effects of the treatment on the part of parents and the psychotherapist, to be revisited one year after the start of the psychotherapy and/or at its completion. The Strength and Difficulties Questionnaire, for parents and schools, was also administered before and after the treatment. The characteristics of the first 30 children referred for psychotherapy over a particular time period are described. Of the first 15 children in this group to complete one year of individual psychotherapy, all showed change or significant change in the areas concerning parents' and therapists' hopes at the end-of-year review, as rated by parents and psychotherapists. A case of a child with conduct disorder is used to describe how the assessment generated a psychoanalytic formulation, how the therapist's understanding was fed back to the parents, and how the parents' and therapist's hopes and expectations were derived and recorded. This case illustrates powerfully the impact of trauma in the parents' backgrounds on the internal world of the child, and how the method provides a useful bridge between parent and child work. Feedback from the psychotherapists, the parents and the referrers using the framework is reviewed, and in conclusion the paper argues for the framework's value in promoting good practice in the treatment and management of complex cases and in enhancing awareness of the nature and scope of the psychotherapy process.     

Killing the dead: evolution of melancholic identifications underlying suicide attempts in adolescence

Psychic processes underlying suicidal behaviours during adolescence and their evolution are explored. A longitudinal study was conducted of thirty adolescent patients hospitalised following a suicide attempt. Clinical interviews were used combined with the Rorschach Test and the Thematic Apperception Test (TAT) a few days after the suicide attempt and one year later. Results initially showed common forms of psychic adjustment: melancholic identifications were linked to an excessive dependence on objects. One year later, these forms of psychic adjustment changed: for many adolescents, the melancholic identifications shifted and self-image improved. The emergence of representations of murder fantasies immediately after the suicidal behaviour allowed a possible transformation of violence into symbolisation. A case study illustrates these psychic changes.     

Agreement and similarity in self-other perceptions of moral character

We surveyed well-acquainted dyads about two key moral character traits (Honesty–Humility, Guilt Proneness), as well as several other individual differences. We examined self-other agreement, similarity, assumed similarity, and similarity-free agreement (i.e., self-other agreement controlling for similarity and assumed similarity). Participants projected their own level of moral character onto their peers (i.e., moderately high assumed similarity), but were nonetheless able to judge moral character with reasonable accuracy (moderately high self-other agreement and similarity-free agreement), suggesting that moral character traits can be detected by well-acquainted others. Regardless of reporting method, Honesty–Humility and Guilt Proneness were correlated with delinquency, unethical decision making, and counterproductive work behavior, suggesting that unethical behavior is committed disproportionately by people with low levels of these character traits.     

Two boys—one event

The background of this paper is an investigation of child survivors from the Holocaust; in a study of interviews of these survivors, it could be concluded that past traumatic experiences are recovered not as memories (in the usual sense of the word), but as affects invading the present. Accordingly, affects seem to tell the story of the past traumatic experiences. In this paper, the author investigates two accounts (separately told by two survivors) of the same event in the Kielce ghetto. The two accounts present similarities, but also differences, and the author discusses these in relation to the concepts of historical and narrative truth, as well as in relation to construction and reconstruction, concluding that the interviews give a sketch of how the experiences have become idiosyncratically registered in the minds of the interviewees.     

Sick? Or slow? On the origins of intelligence as a psychological object

This paper examines the first moments of the emergence of “psychometrics” as a discipline, using a history of the Binet–Simon test (precursor to the Stanford–Binet) to engage the question of how intelligence became a “psychological object.” To begin to answer this, we used a previously-unexamined set of French texts to highlight the negotiations and collaborations that led Alfred Binet (1857–1911) to identify “mental testing” as a research area worth pursuing. This included a long-standing rivalry with Désiré-Magloire Bourneville (1840–1909), who argued for decades that psychiatrists ought to be the professional arbiters of which children would be removed from the standard curriculum and referred to special education classes in asylums. In contrast, Binet sought to keep children in schools and conceived of a way for psychologists to do this. Supported by the Société libre de l'étude psychologique de l'enfant [Free society for the psychological study of the child], and by a number of collaborators and friends, he thus undertook to create a “metric” scale of intelligence—and the associated testing apparatus—to legitimize the role of psychologists in a to-that-point psychiatric domain: identifying and treating “the abnormal”. The result was a change in the earlier law requiring all healthy French children to attend school, between the ages of 6 and 13, to recognize instead that otherwise normal children sometimes need special help: they are “slow” (arriéré), but not “sick.” This conceptualization of intelligence was then carried forward, through the test's influence on Lewis Terman (1877–1956) and Lightner Witmer (1867–1956), to shape virtually all subsequent thinking about intelligence testing and its role in society.     

Young Children's Trust in Overtly Misleading Advice

The ability of 3‐ and 4‐year‐old children to disregard advice from an overtly misleading informant was investigated across five studies (total n = 212). Previous studies have documented limitations in young children's ability to reject misleading advice. This study was designed to test the hypothesis that these limitations are primarily due to an inability to reject specific directions that are provided by others, rather than an inability to respond in a way that is opposite to what has been indicated by a cue. In Studies 1 through 4, a puppet identified as The Big Bad Wolf offered advice to participants about which of two boxes contained a hidden sticker. Regardless of the form the advice took, 3‐year olds performed poorly by failing to systematically reject it. However, when participants in Study 5 believed they were responding to a mechanical cue rather than the advice of the Wolf, they were better able to reject misleading advice, and individual differences in performance on the primary task were systematically correlated with measures of executive function. Results are interpreted as providing support for the communicative intent hypothesis, which posits that children find it especially difficult to reject deceptive information that they perceive as being intentionally communicated by others.     

Inter-hemispheric remapping between arm proprioception and vision of the hand is disrupted by single pulse TMS on the left parietal cortex

Parietal cortical areas are involved in sensori-motor transformations for their respective contralateral hemifield/body. When arms of the subjects are crossed while their gaze is fixed straight ahead, vision of the hand is processed by the hemisphere ipsilateral to the arm position and proprioception of the arm by the contralateral hemisphere. It induces interhemispheric transfer and remapping. Our objective was to investigate whether a single pulse TMS applied to the left parietal cortical area would disturb interhemispheric remapping in a similar case, and would increase a simple reaction time (RT) with respect to a control single pulse TMS applied to the frontal cortical area. Two LED were superimposed and located in front of the subjects on the saggital axis. Subjects were asked to carefully fixate on these LED during each trial. The lighting of the red LED was used as a warning signal. Following the green one was illuminated after a variable delay and served as a go-signal. The hand for the response was determined before the start of each trial. TMS was applied to the left parietal, the left frontal cortical areas, or not applied to the subject. Results revealed that: (1) Irrespective of its location, single pulse TMS induced a non-specific effect similar to a startle reflex and reduced RT substantially (15 ms on average) with respect to a control condition without TMS (mean value = 153 ms). (2) Irrespective of TMS, RT were shorter when the right or the left hand was positioned in the right visual hemi-field (i.e. normal and crossed positions respectively). (3) Finally, RT increased when single pulse TMS was applied to the left parietal area and when hands were crossed irrespective of which hand was used. We concluded that interhemispheric sensori-motor remapping was disrupted by a single pulse TMS that was applied to the left parietal cortex. This effect was also combined with some visual attention directed towards the hand located on the right visual hemi-field.     

Task-load manipulation in the Symbol Digit Modalities Test: An alternative measure of information processing speed

ObjectiveTo evaluate the utility of an oral fMRI-adapted version of the Symbol Digit Modalities Test (SDMT) to assess information processing speed (IPS) using three different interstimulus intervals (ISI).MethodsNineteen right-handed healthy controls performed the adapted version of the SDMT, consisting of a block design that had a total of 6 control/activation block pairs with 3 different ISIs (1.5, 2 and 2.5 s) presented in two different runs: in ascending and descending orders. The brain activation patterns during different ISIs were assessed by effective functional connectivity analysis based on independent component analysis.ResultsAs expected, all conditions yielded activations in the fronto-parietal networks (FPNs) related to attention processes. Shorter ISIs (1.5 and 2 s) not only yielded greater patterns of connectivity within fronto-parietal and occipital regions such as the FPN and fronto-occipital network (FON), but also recruited more functional networks overall. Task performance at the shortest ISI was negatively correlated with connectivity at the FPN and activity of the pre-supplementary motor area extending to the cingulate gyrus.ConclusionIncreasing IPS demands due to shorter ISIs resulted in an increased level and number of functional networks required, increased connectivity within the FPN and FON, and enhancement of the prefrontal cortex. IPS does not arise from activity of a single b area but from affective information transfer among distant cortical regions of the frontal and parietal cortices. This adapted version of the SDMT may be useful for studying alterations of IPS in clinical and nonclinical populations.     

Brief pitch-priming facilitates infants’ discrimination of pitch-evoking noise: Evidence from event-related potentials

Pitch is derived by the auditory system through complex spectrotemporal processing. Pitch extraction is thought to depend on both spectral cues arising from lower harmonics that are resolved by cochlear filters in the inner ear, and on temporal cues arising from the pattern of action potentials contained in the cochlear output. Adults are capable of extracting pitch in the absence of robust spectral cues, taking advantage of the temporal cues that remain. However, recent behavioral evidence suggests that infants have difficulty discriminating between stimuli with different pitches when resolvable spectral cues are absent. In the current experiments, we used the mismatch negativity (MMN) component of the event related potential derived from electroencephalographic (EEG) recordings to examine a cortical representation of pitch discrimination for iterated rippled noise (IRN) stimuli in 4- and 8-month-old infants. IRN stimuli are pitch-evoking sounds generated by repeatedly adding a segment of white noise to itself at a constant delay. We created IRN stimuli (delays of 5 and 6 ms creating pitch percepts of 200 and 167 Hz) and high-pass filtered them to remove all resolvable spectral pitch cues. In experiment 1, we did not find EEG evidence that infants could detect the change in the pitch of these IRN stimuli. However, in Experiment 2, after a brief period of pitch-priming during which we added a sine wave component to the IRN stimulus at its perceived pitch, infants did show significant MMN in response to pitch changes in the IRN stimuli with sine waves removed. This suggests that (1) infants can use temporal cues to process pitch, although such processing is not mature and (2) that a short amount of pitch-priming experience can alter pitch representations in auditory cortex during infancy.     

Birth of an Abstraction: A Dynamical Systems Account of the Discovery of an Elsewhere Principle in a Category Learning Task

Human participants and recurrent (“connectionist”) neural networks were both trained on a categorization system abstractly similar to natural language systems involving irregular (“strong”) classes and a default class. Both the humans and the networks exhibited staged learning and a generalization pattern reminiscent of the Elsewhere Condition (Kiparsky, 1973). Previous connectionist accounts of related phenomena have often been vague about the nature of the networks’ encoding systems. We analyzed our network using dynamical systems theory, revealing topological and geometric properties that can be directly compared with the mechanisms of non‐connectionist, rule‐based accounts. The results reveal that the networks “contain” structures related to mechanisms posited by rule‐based models, partly vindicating the insights of these models. On the other hand, they support the one mechanism (OM), as opposed to the more than one mechanism (MOM), view of symbolic abstraction by showing how the appearance of MOM behavior can arise emergently from one underlying set of principles. The key new contribution of this study is to show that dynamical systems theory can allow us to explicitly characterize the relationship between the two perspectives in implemented models.