A Review of: “Greenwald,R. (2009). Treating Problem Behaviors: A Trauma-Informed Approach.”

This single-case-design experiment examined an intervention to decrease bed-sharing in children, ages 2 through 6. Three sessions were conducted with each parent. At the first session, parents described bed-sharing history and began collecting baseline data. At the second session, parents were instructed to employ the intervention. At the third session, parents were interviewed and offered continued support, if needed. Participants included three children who slept with their parents 4 or more nights per week. The intervention resulted in a substantial decrease in bed-sharing behavior for all participants, and parents reported being satisfied with the intervention.     

Critical Issues in Causation and Treatment of Autism: Why Fads Continue to Flourish

The increasing incidence of autism and the lack of specific answers regarding causation have given rise to unproven educational interventions and medical treatments. Parents of a newly diagnosed child can easily fall prey to interventions that promise cures. These interventions may be harmful and, thus, pose one of the critical issues in special education today. This article will discuss some of the suspect interventions that have been popularized through the media (i.e., celebrities, journalists, and professional organizations). The authors argue that using the scientific method is clearly the antidote for pseudoscience; the need for accurate research-based decision making is apparent.     

Processing of musical structure by high-functioning adolescents with autism spectrum disorders

Enhanced pitch perception and memory have been cited as evidence of a local processing bias in autism spectrum disorders (ASD). This bias is argued to account for enhanced perceptual functioning (Mottron &; Burack, 2001 Mottron, L. and Burack, J. A. 2001. “Enhanced perceptual functioning in the development of autism”. In The development of autism: Perspectives from theory to research, Edited by: Burack, J. A., Charman, T., Yirmiya, N. and Zelazo, P. R. 131–147. Mahwah, NJ: Lawrence Erlbaum.  [Google Scholar]; Mottron, Dawson, Soulières, Hubert, &; Burack, 2006 Mottron, L., Dawson, M., Soulières, I., Hubert, B. and Burack, J. 2006. Enhanced perceptual functioning in autism: An update, and eight principles of autistic perception. Journal of Autism and Developmental Disorders, 36(1): 27–43. doi:10.1007/s10803-005-0040-7[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) and central coherence theories of ASD (Frith, 1989 Frith, U. 1989. Autism: Explaining the enigma, Oxford: United Kingdom: Blackwell.  [Google Scholar]; Happé &; Frith, 2006 Happé, F. and Frith, U. 2006. The weak coherence account: Detail-focused cognitive style in autism spectrum disorders. Journal of Autism and Developmental Disorders, 36(1): 5–25. doi:10.1007/s10803-005-0039-0[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). A local processing bias confers a different cognitive style to individuals with ASD (Happé, 1999 Happé, F. 1999. Autism: Cognitive deficit or cognitive style?. Trends in Cognitive Sciences, 3(6): 216–222. doi:10.1016/S1364-6613(99)01318-2[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]), which accounts in part for their good visuospatial and visuoconstructive skills. Here, we present analogues in the auditory domain, audiotemporal or audioconstructive processing, which we assess using a novel experimental task: a musical puzzle. This task evaluates the ability of individuals with ASD to process temporal sequences of musical events as well as various elements of musical structure and thus indexes their ability to employ a global processing style. Musical structures created and replicated by children and adolescents with ASD (10–19 years old) and typically developing children and adolescents (7–17 years old) were found to be similar in global coherence. Presenting a musical template for reference increased accuracy equally for both groups, with performance associated to performance IQ and short-term auditory memory. The overall pattern of performance was similar for both groups; some puzzles were easier than others and this was the case for both groups. Task performance was further found to be correlated with the ability to perceive musical emotions, more so for typically developing participants. Findings are discussed in light of the empathizing-systemizing theory of ASD (Baron-Cohen, 2009 Baron-Cohen, S. 2009. Autism: The Empathizing-Systemizing (E-S) Theory. Annals of the New York Academy of Sciences, 1156: 68–80. doi:10.1111/j.1749-6632.2009.04467.x[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) and the importance of describing the strengths of individuals with ASD (Happé, 1999 Happé, F. 1999. Autism: Cognitive deficit or cognitive style?. Trends in Cognitive Sciences, 3(6): 216–222. doi:10.1016/S1364-6613(99)01318-2[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]; Heaton, 2009 Heaton, P. 2009. Assessing musical skills in autistic children who are not savants. Philosophical Transactions of the Royal Society Biological Sciences, 364: 1443–1447. doi:10.1098/rstb.2008.0327[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]).     

Deeper attentional masking by lateral objects in children with autism

Autism spectrum disorder (ASD) is often associated with a detail-oriented perception and overselective attention in visual tasks, such as visual search and crowding. These results were obtained manipulating exclusively the spatial properties of the stimuli: few is known about the spatio-temporal dynamics of visual processing in ASD. In this study we employed an attentional masking (AM) paradigm comparing children with ASD and IQ-matched typically developing (TD) controls. The AM effect refers to an impaired identification of a target followed by a competitive masking object at different proximities in space and time. We found that ASD and TD groups did not differ in the AM effect provoked by the competitive object displayed in the same position of the target. In contrast, children with ASD showed a deeper and prolonged interference than the TD group when the masking object was displayed in the lateral position. These psychophysical results suggest that the inefficient attentional selection in ASD depends on the spatio-temporal interaction between competitive visual objects. These evidence are discussed in the light of the ASD altered neural connectivity hypothesis and the reentrant theory of perception.     

Psychometric evaluation of the eating disorder inventory (edi) in a clinical group

Abstract

This study examined the psychometric properties of the Eating Disorder Inventory (EDI) with a clinical sample of 79 female clients seen at an outpatient eating disorder program. The means and standard deviations for the bulimia nervosa subgroup in this study (n = 48) compared favorably with the bulimia group in the EDI Manual Supplement (1986) on all eight subscales, except Drive for Thinness. The present non-student sample had significantly lower scores on this particular subscale than did the norm group (mostly students). Another difference was that the local bulimic subgroup had significantly higher present and minimum weights (as a percentage of the expected average weight according to height). The EDI subscales also displayed respectable internal consistency reliability with this sample. In contrast to previous research, however, only five factors were found in a factor analysis rather than eight corresponding to the original subscales for the EDI. Differences between bulimic and a not-otherwise-specified (NOS) diagnostic groups were also found on both the EDI Ineffectiveness and Bulimia subscales (NOS had lower scores). The results of this study are discussed in terms of the importance of undertaking local standardization of tests in clinical settings.     

Psychosocial consequences of recurrent vertigo

Abstract

Chronic vertigo is known to be associated with anxiety and depression in a significant proportion of patients, but there have been no systematic investigations into beliefs and behaviour related to recurrent vertigo. Twenty-three individuals with vertigo of various types were interviewed, generating over two thousand statements about vertigo and its psychosocial consequences. By means of progressive categorisation these were condensed into four tables of summary statements representing prevalent reactions to and effects of vertigo. Vertigo is viewed as intrinsically frightening and potentially stigmatising. In an attempt to avoid provoking attacks, particularly in public, subjects tended to impose restrictions on their activities and lifestyle which generated further feelings of helplessness and frustration. The statements obtained in this study provide an empirical basis for the development of a model that may be used to formulate predictions about the relationship between vertigo, handicap and distress, and the benefits of intervention.     

Attentional deficits in fibromyalgia and its relationships with pain,emotional distress and sleep dysfunction complaints

Cognitive complaints are common among subjects with fibromyalgia (FM). Yet, few studies have been able to document these deficits with cognitive tasks. A main limitation of existing studies is that attention has been broadly defined and the tasks used to measure attention are not designed to cover all the main components of the attentional system. Research on attention has identified three primary functions of attention, known as alerting, orienting and executive functioning. This study used the attentional network test-interactions task to explore whether and which of the three attentional networks are altered in FM. Results showed that FM patients have impaired executive control (greater interference), reduced vigilance (slower overall reaction time) and greater alertness (higher reduction in errors after a warning cue). Vigilance and alertness showed several relations with depression, anxiety and sleep quality. Sleep dysfunction was a significant predictor for alertness, whereas there were no significant predictors for vigilance. These findings highlight that the treatment of sleep difficulties in FM patients may help with some of their cognitive complaints.     

A comparison of working memory profiles in school-aged children with Specific Language Impairment,Attention Deficit/Hyperactivity Disorder,Comorbid SLI and ADHD and their typically developing peers

The association between specific language impairment (SLI), attention deficit/hyperactivity disorder (ADHD), and working memory (WM) was examined. WM has been implicated in language acquisition and models of ADHD; however, evidence for WM deficits in SLI and ADHD has been inconsistent. The components of Baddeley's WM model were investigated in 18 children with SLI, 16 children with ADHD, 11 children with comorbid SLI+ADHD, and 24 typically developing (TD) children. The presence of SLI resulted in deficits in more components of WM than the presence of ADHD indicating that children with SLI are more vulnerable to WM deficits than those with ADHD.     

Autism characteristics in children with fetal alcohol spectrum disorders

Background: Children with fetal alcohol spectrum disorders (FASD) exhibit difficulties in many cognitive and behavioral domains and also have high comorbidity with other disorders such as attention deficit/hyperactivity disorder (ADHD) and conduct disorder as well as autism. Although the FASD profile is shown to be distinct from ADHD and conduct disorder, far less is known about the commonalities with autism. The current study used a parent-rated questionnaire containing an autism subscale to explore the autistic-like features that children with FASD exhibit. Methods: Studied were 25 children with FASD (age: M = 10.3 years) and 17 normal controls (NCs; age: M = 10.2 years). As part of a larger study, all parents/caregivers completed the Social Skills Improvement System (SSIS; Gresham & Elliot, 2008), which in addition to evaluating social skills and behavior problems globally, includes an Autism subscale. Results: Between-group comparisons showed the FASD group not only scored significantly lower in social skills and significantly higher in behavior problems than the NC group but children with FASD also scored significantly higher on the Autism subscale. Item analysis revealed they showed the most difficulty in terms of social and communicative functioning and the least in repetitive and restrictive behaviors. Conclusion: Current findings signify that FASD and autism share similarities with regard to social and communicative functioning. These findings, which further our knowledge of the FASD phenotype, may be useful in specifying the particular interventions these children need.     

Enhancing recovery rates: Lessons from year one of IAPT

BackgroundThe English Improving Access to Psychological Therapies (IAPT) initiative aims to make evidence-based psychological therapies for depression and anxiety disorder more widely available in the National Health Service (NHS). 32 IAPT services based on a stepped care model were established in the first year of the programme. We report on the reliable recovery rates achieved by patients treated in the services and identify predictors of recovery at patient level, service level, and as a function of compliance with National Institute of Health and Care Excellence (NICE) Treatment Guidelines.MethodData from 19,395 patients who were clinical cases at intake, attended at least two sessions, had at least two outcomes scores and had completed their treatment during the period were analysed. Outcome was assessed with the patient health questionnaire depression scale (PHQ-9) and the anxiety scale (GAD-7).ResultsData completeness was high for a routine cohort study. Over 91% of treated patients had paired (pre-post) outcome scores. Overall, 40.3% of patients were reliably recovered at post-treatment, 63.7% showed reliable improvement and 6.6% showed reliable deterioration. Most patients received treatments that were recommended by NICE. When a treatment not recommended by NICE was provided, recovery rates were reduced. Service characteristics that predicted higher reliable recovery rates were: high average number of therapy sessions; higher step-up rates among individuals who started with low intensity treatment; larger services; and a larger proportion of experienced staff.ConclusionsCompliance with the IAPT clinical model is associated with enhanced rates of reliable recovery.