Kidney Transplants From Young Children and the Mentally Retarded

Kidney donation by young children and the mentally retarded has been supported by court decisions, arguments based on obligations inherent in family relationships, an array of contextual factors, and the principle of beneficence. These justifications for taking organs from people who cannot protect themselves are problematic and must be weighed against our obligation to protect the vulnerable. A compromise solution is presented that strongly protects young children and the mentally retarded but does not abdicate all responsibility to relieve suffering. Guidelines are proposed that prohibit the retrieval of kidneys from young children and the mentally retarded but permit one exception. They would allow retrieval of a kidney when the consequence to a first order relative with whom the donor has a meaningful and valuable relationship is otherwise imminent death. This would be done in accordance with additional guidelines that minimize harm to the donor. Since most patients with end stage renal disease can be maintained on dialysis the need for a kidney to prevent death should be an uncommon occurrence. This compromise is proposed as a solution to a dilemma that exists because two ethical principles are in conflict and one cannot be honored without violating the other.     

Chapter 6 Developmental Perspectives in Brief Treatment of Gay Youth

Abstract

This report explores representative dilemmas of gay youth in the transition from late adolescence to young adulthood and shows how brief treatment may facilitate efforts to work toward greater authenticity in sense of self and identity, revise maladaptive relational patterns, and strengthen coping capacities. It presents the case of an 18-year-old male who was seen in supportive psychodynamic treatment for 13 sessions in a university counseling service. Developmental and relational deficits, rooted in a stigmatized identity, perpetuated problems in functioning. The relational functions and supportive elements of the therapeutic process are emphasized in discussion of curative factors. Establishment of the selfobject bond with the therapist strengthened self, facilitated coping, and improved social functioning. The author emphasizes the importance of considering the impact of internalized homophobia and self-alienation in assessment of functioning and establishment of treatment goals.     

Independent and social play among profoundly mentally retarded adults: training, maintenance, generalization, and long-term follow-up.

Play skills were taught to eight profoundly mentally retarded adults in two interrelated experiments. In Experiment 1, a multiple baseline across subjects design was used to assess the efficacy of verbal and physical prompts on independent play. In Experiment 2, the same subjects and experimental procedures were used to develop social play. Verbal prompting and graduated physical guidance procedures were found to be effective in substantially increasing independent play in Experiment 1 and social play in Experiment 2. Positive changes were also observed in collateral behaviors. Inappropriate play decreased slightly and stereotypy decreased to very low levels. Social interaction increased substantially in Experiment 2 when social play was targeted but little change was observed in Experiment 1 when only independent play was targeted. Treatment gains were maintained for 26 weeks in Experiment 1 and 10 weeks in Experiment 2. In addition, the treatment gains were generalized across subjects and settings in Experiment 2. Finally, regular follow-up checks showed that independent and social play remained in the repertoire of the subjects for 12 months following the termination of programmed maintenance.     

Conditional discrimination in mentally retarded adults: the development of generalized skills.

The development of generalized conditional discrimination skills was examined in adults with retardation. Two subjects with histories of failure to acquire arbitrary matching under trial-and-error procedures were successful under procedures that trained one or more prerequisite skills. The successive discrimination between the sample stimuli was established by training the subjects to name the stimuli. The simultaneous discrimination between the comparison stimuli was established using either (a) standard simple discrimination training with reversals or (b) a procedure in which each of the two sample-comparison relations in the conditional discrimination was presented in blocks of trials, with the size of the blocks decreasing gradually until sample presentation was randomized. The amount of prerequisite training required varied across subjects and across successive conditional discriminations. After acquiring either two or three conditional discriminations with component training, both subjects learned new conditional discriminations under trial-and-error procedures. In general, each successive conditional discrimination was acquired more rapidly. Tests showed that conditional responding had become a generalized skill. Symmetry was shown for almost all trained relations. Symmetry trial samples were ultimately named the same as the stimuli to which they were related in training.     

弱智儿童心理旋转的研究

该研究探讨了一组9~12岁弱智儿童的“心理旋转”能力,该组儿童平均年龄10.1岁,平均智商（IQ）53.8（中度智力残疾）。研究结果与正常儿童（均龄8岁）作了比较。结果显示,弱智儿童的心理旋转能力明显较之正常儿童为差,智力缺陷对视觉图形空间定向能力（心理旋转）有着明显的影响。但无论弱智儿童或是正常儿童的结果均未发现性别差异。     

弱智儿童在上课时和自由活动时的行为表现

研究了４１名弱智儿童。采用时间样本的方法收集材料,以期从动态角度了解弱智儿童在上课时和自由活动时的行为表现。按园别和智力落后程度两个方面对被试在上课时的８大类行为和自由活动时的７大类行为进行了分析。结果发现：班级人数、不同教学方法和智力落后程度与弱智儿童的行为表现有关。还对收集材料的方法、园别和智力落后程度与弱智儿童的行为表现的关系、高频率的自娱活动等,进行了讨论。最后,根据研究结果对教师提出了教学建议。     

Outcomes for Children and Adolescents After Residential Treatment: A Review of Research from 1993 to 2003

The focus of this research review is to determine what factors increase the likelihood that positive individual and systemic changes occur for children and adolescents following discharge from residential treatment. Residential treatment outcome studies from 1993 to 2003 that fulfilled predetermined criteria were located through 4 on-line databases using key word combinations. The research selected was: (a) 7 studies that measured outcome immediately upon completion of treatment and discharge, and (b) 11 studies where outcome progress was assessed at one or more follow-up dates after discharge. Results showed that children and adolescents with severe emotional and behaviour disorders can benefit and sustain positive outcomes from residential treatment that is multi-modal, holistic and ecological in its approach. Similar to the clinical child psychotherapy research, conclusions must be tempered due to the limited number of studies and methodological weaknesses. Future considerations highlight how research results can more realistically reflect intervention effectiveness when elements of the ecological and systemic landscape of care are addressed.     

TIME DELAY: A TECHNIQUE TO INCREASE LANGUAGE USE AND FACILITATE GENERALIZATION IN RETARDED CHILDREN

Institutional breakfast-serving procedures were manipulated to assess what effect changes in that aspect of the environment would have on requests for food. During baseline, six severely retarded children were required to pick up their food trays and return to their seats. The first manipulation, delaying the giving of the food tray for 15 seconds, served as a cue to evoke meal requests by three of the six children. Two of the remaining three required a model of an appropriate meal request (i.e., “Tray, please.”) at the end of the 15-second delay before they began requesting their meals. To evoke meal requests from the sixth child, an intensive training procedure, consisting of massed trials of delay and modeling, was required. Three different probes were administered to assess generalization across the people serving the meals, across mealtimes, and across both people and mealtimes. Typically, generalized responding in these new situations could be prompted by use of the 15-second delay procedure. Functional aspects of the delay procedure and its potential usefulness for evoking speech and facilitating generalization are discussed.