医学方法论的新探索──第四届全国中青年医学方法论学术讨论会总结

医学方法论的新探索──第四届全国中青年医学方法论学术讨论会总结医学与哲学杂志社（１１６０１３）王国强,宋文波由中华医学会心身医学学会与中国自然辩证法研究会《医学与哲学》杂志社联合召开的“第四届全国中青年医学方法论学术讨论会”,于１９９５年３月１３日到...     

Vicarious reinforcement: Expected and unexpected effects

The primary purpose of this study was to examine the effects on one child of observing another child receive direct social reinforcement. In the first part of the study, pairs of same-sex children worked on puzzles for three sessions spaced 2 to 3 days apart. One child was praised on a continuous schedule for performance, whereas the other received no praise. Although children who observed other children being praised increased their performance initially (as predicted by vicarious reinforcement and social comparison hypotheses), their performance decreased over time, reaching levels below their own baseline rates. In the second part of the study, intermittent praise delivered to the observing child was examined as a potential strategy to reverse the unexpected effects obtained in the first part of the study. Intermittent praise was found to be effective in reducing these effects and in producing enhanced performance. Individual data, as well as group data, are presented. Results are discussed in light of theoretical and applied issues related to the use of vicarious reinforcement in applied settings.     

Category induction from distributional cues in an artificial language

The ability to identify the grammatical category of a word (e.g., noun, verb, adjective) is a fundamental aspect of competence in a natural language. Children show evidence of categorization by as early as 18 months, and in some cases younger. However, the mechanisms that underlie this ability are not well understood. The lexical co-occurrence patterns of words in sentences could provide information about word categories--for example, words that follow the in English often belong to the same category. As a step in understanding the role distributional mechanisms might play in language learning, the present study investigated the ability of adults to categorize words on the basis of distributional information. Forty participants listened for approximately 6 min to sentences in an artificial language and were told that they would later be tested on their memory for what they had heard. Participants were next tested on an additional set of sentences and asked to report which sentences they recognized from the first 6 min. The results suggested that learners performed a distributional analysis on the initial set of sentences and recognized sentences on the basis of their memory of sequences of categories of words. Thus, mechanisms that would be useful in natural language learning were shown to be active in adults in an artificial language learning task.     

Issues in Parent-Child Agreement: The Case of Structured Diagnostic Interviews

There are three primary purposes of this review. First, the review distinguishes among three types of reliability and describes the importance of evaluating the reliability of child psychopathology assessment instruments for clinical practice and research. Second, parent-child reliability findings from 5 of the more carefully studied and frequently used Structured (semi and highly) diagnostic interviews (The Schedule for Affective Disorders and Schizophrenia for School-age Children, The Child Assessment Scale, The Anxiety Disorders Interview Schedule for Children. The Diagnostic Interview for Children and Adolescents, and the Diagnostic Interview Schedule for Children) are examined. Finally, this review explores factors that have been implicated in terms of their potential effect on parent-child agreement. In addition, future directions for research and clinical practice within this area are identified and potential resolutions to the conundrum of parent-child discordance are discussed.     

The Collaborative Longitudinal Personality Disorders Study: reliability of axis I and II diagnoses

Both the interrater and test-retest-retest reliability of axis I and axis II disorders were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV). Fair-good median interrater kappa (.40-.75) were found for all axis II disorders diagnosed five times or more, except antisocial personality disorder (1.0). All of the test-retest kappa for axis II disorders, except for narcissistic personality disorder (1.0) and paranoid personality disorder (.39), were also found to be fair-good. Interrater and test-retest dimensional reliability figures for axis II were generally higher than those for their categorical counterparts; most were in the excellent range (> .75). In terms of axis I, excellent median interrater kappa were found for six of the 10 disorders diagnosed five times or more, whereas fair-good median interrater kappa were found for the other four axis I disorders. In general, test-retest reliability figures for axis I disorders were somewhat lower than the interrater reliability figures. Three test-retest kappa were in the excellent range, six were in the fair-good range, and one (for dysthymia) was in the poor range (.35). Taken together, the results of this study suggest that both axis I and axis II disorders can be diagnosed reliably when using appropriate semistructured interviews. They also suggest that the reliability of axis II disorders is roughly equivalent to that reliability found for most axis I disorders.     

The Collaborative Longitudinal Personality Disorders Study: development, aims, design, and sample characteristics

This paper describes the aims, background, design, and methods used in a collaborative longitudinal study of Axis II personality disorders (PDs). This study examines the putative stability of selected PD diagnoses and criteria, what factors affect their course, and whether their stability and course distinguishes them from a representative Axis I disorder. This article also describes the acquisition and demographics of the sample on whom the study is being done. A prospective, repeated measures investigation of the stability of PDs is now underway at multiple clinical settings in four collaborating urban sites in Boston. New Haven, New York, and Providence. Diagnostic assignments are based on semistructured interview assessments (by clinically trained raters) and confirmed by at least one additional contrasting diagnostic method. The sample consists of 668 treatment seeking and reliably diagnosed adults recruited from a broad range of clinical sites. By design, patients in the sample met standards for one of five diagnostic subgroups: (a) schizotypal (N = 86); (b) borderline (N = 175); (c) avoidant (N = 157); (d) obsessive-compulsive (N = 153) personality disorders or a control group having (e) major depressive disorder without personality disorder (N = 97).     

Sex offenders, sentencing laws and pharmaceutical treatment: a prescription for failure

The phenomenon of adults who have sexual interests involving children as partners, or pedophiles, is considered among the most sociopathological of human conditions. Considerable literature is devoted to issues and problems associated with or related to pedophilia, including prevalence, etiology, treatment, and outcome studies. The sexual victimization of children, based upon data gathered from a number of sources, suggests an intractable problem that is national in scope. Recent manifestations of society's efforts to deal with the sexual victimization of children include the enactment of criminal sentencing laws that mandate the treatment of offenders with certain pharmaceutical agents, such as medroxy-progesterone acetate ("MPA"). Because sentencing laws as a rule vary widely from state to state, there is considerable variation as to who is subject to MPA treatment laws, and how such laws-including specific provisions, such as clinical criteria, if any, required for treatment; type and period of treatment plans; informed consent; etc-are implemented. Most important, these sentencing laws may have remarkably little relation to what is widely considered effective treatment for pedophilia disorders. We examine in detail the most recent sentencing laws pertaining to treatment of persons who have been convicted of sex offenses involving children as victims. Our critique may offer insight and suggestions as to how such sentencing laws can be more suitably tailored to the treatment needs of persons with pedophilia disorders.